Christmas 2012: Florence, Pisa and Rome Italy

Wow!
This was our Christmas present to the family 20-28 December in Italy.

Duomo Florence Italy

This Christmas was extra special because Clark and MJ's cousin Russell, from Colorado, was able to join us on the vacation.  We had a good news as we departed that his mother's Lukemia was cured from the bone marrow transplant and now it was just a matter of time in strengthening the immune system.
Our departure was on 19 Dec about 4pm - we walked down the hill to the train station, took the express train to Munich and then boarded the overnight train (8pm) for Florence (arrival 6:15am).  That was an experience in and of itself.  A couple of lessons learned, if you are traveling with kids, book the extra seat / berth in the car with Mickey Mouse if you have to!  It was not fun having a stranger in the car with us.  2nd, wear PJ's under the clothes, so there is no changing, as there isn't room for changing (at least not in the couchette).  3rd, plan to brush your teeth in the train station before departure, the water tastes awful on the train and 4th wear your shoes if you need to go to the bathroom.  Honestly, think of this as business class on a plane - lying flat while traveling is great.  All three kids actually slept for at  least 6 hours and Sean and I probably got about 4 hours, but it was enough to function and not feel total frustration the following day in a city where none of us spoke the language.

Leaning tower of Pisa

Arrival in Florence was cool, but not cold (after below 0 in Germany, 8-10 felt really good).  Our apartment was not ready so we started looking for a warm place to hang out for a few hours until things opened up and what do we see but a Burger King (not yet open) and McDonalds (open 24hrs).  So, off to McDonalds.  Ordered breakfast, now, their breakfast is much better than the normal fare and the best part is they brew Italian coffee and make the real hot chocolate pudding style.  Oh, my goodness that was the best hot chocolate of the trip!  We tried it in many boutique style coffee shops and while the espresso there is to die for, the hot chocolate was best at McDonalds.  Lesson, if you go to Italy with kids it is actually ok to do a fast food restaurant, just don't go to the main counter, go their cafe and get the local version of American foods.
After enjoying breakfast, we headed to the tourist information place across the street and started learning about our new "home" for the next week.

Gladiators and nobles of Rome

Lessons learned - 1) if you go to Florence in the couple of weeks before Christmas you don't need to make any reservations for museums and you don't need to spend the money on the Florence card.  We had heard horror stories of waiting in lines forever to get in, but that is the week after Christmas and during the high season.  So, rule of thumb, if you can find a place to stay that is centrally located and discounted, this is the very low season and you won't need to spend the extra money.  2) read a map, if the apartment looks close, it is!  We were told by the apartment managers that we would need a taxi to get to our apartment - the taxi took us on a lovely tour of small, one-way streets for 15 minutes, while our feet would have taken all of 5 minutes on lovely small one-way streets.  I mean we did walk 3.5 km from our house to the train station; we could have definitely handled the .75km walk in Florence.  3) when an apartment is listed as sleeps 6 think it sleeps 4 and then a cat (fortunately MJ is not much bigger than a cat); because that apartment was really, really small.  The bathroom for Sean and I - we walked in and to close the door, we had to step into the shower.  They don't have a lot of space in these old cities.  Fortunately, we pretty just slept in the apartment and that was really all we could do with 5 people in a space that tight.
We rented an apartment on the central market in Florence for our vacation.  It is a great location because not only could we dine, but we could shop for some amazing foods - watched fresh pasta being made.  Saw parts of animals that I have no idea how to cook or utilize, kids thought the intestines, stomachs, brains, feet and tongues were not edible. They were not thrilled to hear about all of the foods that they eat on a regular basis that include these parts.

Sight-seeing, well that is what the photos are for.  I have tried to put as much information on the different photos that I could.
20-22 Dec was spent in Florence
23-24 Dec was spent in Rome
25 Dec Florence (only a few places were open, but that was fine with us, as we actually wanted to skype with some friends and family members) and the best meal of the trip!
26 Dec Pisa
27 Dec Florence and then the night train home to Germany, with lessons learned.

The photos are grouped by Florence / Pisa  and then Rome.

There are a lot, but I hope you enjoy them, because we certainly had fun taking them.  Oh, and we want to go back, so anyone interested in coming over for a visit?

LRMC - Sean's job

After writing the Christmas letter I realized that there is just so much that I wanted to share and I didn’t.  We have tried to keep the blog about the travels, but I also realize that there is a lot more to our lives than traveling, despite my best efforts.

Last year we shared a little about the kid’s school, so this time I thought I would let you know a little more about Sean and I and the work that we are doing here at Landstuhl Regional Medical Center a.k.a LRMC.

Sean, as you know, is a critical care medicine doctor and that translates into he works in the ICU.  Most of the patients he cares for will never actually get to know him as they are on ventilators and extremely sick or injured.  When we first arrived the unit was very busy; however, in the past 6 months it has slowed down tremendously.  A very good thing for our soldiers down range.  The first year Sean was very blessed to have Dr. Silvey stay for an extra year to provide much appreciated mentoring.  Dr. Silvey had been here for 6 years and was able to provide the institutional memory plus hand over responsibilities more slowly than normally happens.  Most transitions are about 2 weeks leaving the new physician feeling very overwhelmed and under-equipped. 

This ICU is different from typical units – it is a Trauma service for 90% of the patients which means it is dominantly surgical cases and then 10% medicine – think pneumonia type stuff.  So, the team rounds with surgeons and medicine physicians and in many cases each patient has 3-4 physicians providing input to their care.  The biggest concern with units like this one is physician and nurse burnout.  With the decrease in patients and the number of physicians we have here the physicians are rarely on more than 7 days in a row with 2 nights of call.  Sometimes due to vacations or training the schedule can be up to 14 days, but that is very rare.  Last spring we were fortunate enough to have it be 7 days on in the unit and 14 days from the unit.  So, the first question that normally comes to mind is 14 days off, really?  No, not really.  Those 14 days are filled with military training and then administrative work to keep the hospital going. 

Sean serves on a number of committees and has taken on the role of education coordinator for the Trauma service; that means that when trainees are in the hospital he is responsible for their scheduling and educational activities and then providing feedback at the end of the rotation.  He is also responsible for scheduling all of the physicians, when they are on-call during their assigned weeks in the unit.   This fall he also took on the job of being the project manager for replacing all of the defibrillators in the hospital and clinics affiliated with LRMC that was more than 200 machines and lots of red tape!  Now, his administrative time will be filled with helping to update the notification systems for when there are different staffing needs.  With the military cutting back on soldiers downrange they will also be cutting back on staffing for LRMC making it so that physicians will be able to be on-call from home instead of in-house because they will be on-call more often. 

In January, Sean will head back to the states for 2 weeks to cover the ICU at Ft. Bragg – this will be an on for 6 days, off for 1 deal with coverage extending into the night.  Bragg does have a family practice residency so there will be a resident there to make the initial assessments and then they will call him for advice and guidance.  

When he returns he will start covering the hospitalist service at night to keep his skills up there, that is general medicine inpatient services, think kidney failure and other reasons people spend a few days in the hospital.  Then he will also start to train for special flight missions.  He is part of the lung team; that means he flies to pick-up a patient that is in respiratory distress and can’t fly without mechanical assistance.  2-3 physicians plus nurses and other trained professionals are all part of the team and they are normally gone for 24+hours.  Sometimes longer if that patient is not stable enough to fly, but never shorter – it just takes that long to fly.  Once he gets additional training he will be provide greater support for those soldiers.  There are a lot of very unique and special opportunities for his professional growth here and while we go for some extended times with him being at work, this has actually been the most relaxed schedule and work environment since before medical school.  It doesn’t hurt that when he is off, we can take off for something interesting or different.