On Eagle's Wings

When I was a scout, and the Boy Scouts of the United States of America, there was very little that I ever wanted to do with the outside world. It was pulling teeth to even contemplate dragging me on a camping trip, and four out of six years I went to summer camp I probably was unofficially awarded the biggest pansy award. I love my novelty of indoors, but mostly just missed showering and did not have an affinity for sweating constantly. However, even after sitting a Tenderfoot for 2 years, I never stop giving up on rank advancement. My dad only made it to life Scout, and he really wanted me to strive for Eagle Scout and push myself. It has definitely come in handy and anyways since then, and I was bound upon that further in a book.

As for now, it is important to understand that the feat was accomplished. I was able to get my Eagle Scout award after 10 years of service to the BSA. To this day, I come back as I'm able to and assist as a junior assistant scoutmaster. I learned as much as I could, overcame a lot of adversity, and even eventually learned how to survive being out of the house.

Not only did being in Boy Scouts contribute to my passion of travel, but it really taught me how to appreciate nature and all of its small intricacies. Although I am also guilty myself, I must mention that there is so much that you miss when they are staring down at a small little computer screen in your hand. Being in Scouts, we were not allowed to have technology with us on trips in my troop, or it'd be confiscated, screwed with, and then given back to us after the trip. I didn't want any of the above to happen, so I was pretty complacent.

Although I have switched troop snow as I've grown older, being a scoutmaster for a younger troop with fewer members, some of my best memories were with my old troop, troop 94. In 9th grade, we met up with a sister troop from Duncannon, an hour away from us, and we canoed and kayaked 40 miles on the Juniata River over an entire weekend. We hit the bike trails of Gettysburg, slept in the Backwoods of northeast Pennsylvania, visited the military base in the USS battleship, took a couple of historical hikes with lots of information, hiked the Appalachian Trail, and just in general got out and enjoyed nature and did things that the average teenager wouldn't do on a weekend.

Scouting taught me basic essential life skills that have helped me in every aspect of my life. Even the 12 point Scout Law and Scout Oath have become integral Dogma and my interactions with other human beings, and have been practiced so thoroughly that they are now a subconscious part of who I am. And now, I get to pass my experiences and scouting down to next generation of Scouts and leaders. Who knows, one of the kids I am teaching the day could end up being our surgeon general or President...

There are 12 points of the Scout Law, the Scout Law is as follows:

 A scout is trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, and reverent.

The Scout Oath:

As an American, I will do my best, to do my duty, to God and my country, and to obey Scout Law. To help other people at all times. To keep myself physically strong, mentally awake, and morally straight.

If you combine these things with a passion for being outside and putting the out into Scout, experiencing everything that you possibly can, then you will make a Great Scout. Your average teenager won't be putting on three layers of jackets and sleeping on the ground in the middle of the Woods, surviving off of rations and scavenged food and the fire that you've learned how to build yourself without matches. The average teenager will not go mountain climbing, where hiking, or seeing historical sites on the week end. They will not explore nature, meet friends with common interests, shoot at targets, throw hatchets, make explosions (usually when a rocket launch goes wrong), learn 23 life skills over a few years while still young, or organize and lead a conservation project. These are all things that scouts do, and if you're serious about it, you'll even ascend to Eagle.

Park Contemplations

One day in April, I was working on my book at a local park. I was using my voice text on my phone to type up notes concerning the book I was writing about dementia care at the time. When I got to the park, there were two groups of children playing on the big toy and the swingset respectively. From being out in nature and typing my notes, catching up on some much-needed Vitamin D from the winter months, I noticed a couple of things:

1) Kids actually still go outside.

In process of getting older, although only 23 at the time, I've grown quite cynical of generations below me. Just as the generation before me was under the assumption that Millennials would amount to very little, I was under the impression that the Youth of Generation Z would be hiding and doors, engaging an antisocial activities and sitting on their cell phones and Xbox all day long. I was happy to note that this was not the case, and that on a wonderful day such as today, they were still outside enjoying the Sun at each other's company.

2) The youth in 2018 used much more vulgarity.

when I was a kid, if you use any sort of vulgar language, your mouth got smacked. Now, I would place these children at about 7 to 12 years old, and they swear like sailors. Very fascinating.

3) Their language is much more inclusive then the generations before.

I actually overheard a conversation with two of the older kids as they were talking about lgbtq and trying to identify who in the group might be. They talked about it openly, however, which is something that would have never happened when I was their age. this could potentially be the beginnings of positive culture change.

4) They still play games together.

One group of children were sitting at the big toy chatting away together, and another group went up to the basketball court to play kickball together. I'm so glad to see that kids are still going outside and participating in Pro social activities and games together, as I thought it was a long lost art myself. I just hope this continues for years to come.

I am by no means whatsoever bashing on any one particular generation or group of individuals in general. I am simply noticing observations I made about the world around me in recent years. Things are changing rapidly, and sometimes, I feel as though I cannot keep up. However, that's for the way the world is going, it's not as bad as people interpret it to be. Kids still have the ability to have kids, and exercise that right freely. We are all getting older, there's nothing we can do to change that. So it's important to remember to slow down and enjoy the sunlight at the park once in awhile.

The Longest Road in America

No hiker's guidebook would be complete without mentioning the Appalachian Trail. This Trail starts in Maine, with Mount Katahdin, One of the highest and hardest state highpoints, and spans 2100 miles of Urban and Wilderness hiking, ending at Springer Mountain, Georgia. There are a lot of hostels along the way with historic stops and sightseeing, and of course, lots and lots of Switchback hiking.

Although I haven't personally done a whole lot of Appalachian Trail hiking, I have read stories about

people who go through hiking on the trail, and I have hiked a little bit of it myself. If you want to plan a hike, you need to know how far you plan to go, how long you're going to be on the trail each day, and lots of Prior planning for costs and food and shelter. I have seen videos ofI have seen videos of people preparing for the trip, planning their hiking course, and seeing a living room floor completely covered in two layers of non-perishable and freeze-dried foods. I have encountered people who have gone hiking on the trail, and they have told me their expenses and their costs and whatnot.

The first time I did any hiking on the Appalachian Trail, it was on the portion in Pennsylvania right above Duncannon. We hiked about five miles, stopping for snacks and pictures along the way. I was 10 years old and it was very intense. Fast forward a couple years, and I've hiked a little bit more of it, hiking the portion right next to Duncannon, and also hiking 5 miles of it near Mount Rogers in Virginia. The hiking on the Appalachian Trail is some of the hardest hiking I have done so far, as the climate and terrain can change so rapidly out on the fields.

If you're planning to hike the Appalachian Trail, it is most important to set a reasonable pace for yourself. Decide whether or not you want to thruhike, section hike, or just go out for a couple miles to say that you hiked on the trail. The first aid kit should always be utilized, and compression bandages never hurt either. The first time I hiked the trail, I got a blister, and mole skin came to me as a godsend. The second time I hiked, I pulled a muscle in my knee, and I needed to go out and buy a compression stocking to alleviate the pain for the rest of my trip.

You'll Appalachian Trail also has some of the most versatile flora and fauna I've ever seen, and the same goes for the trail itself. One second, you are trotting along through flat grassy paths, and the next you are scrambling over rocks. Another part of the trail, there was completely flooded due to a rainstorm two nights prior and the grounds not being as porous in that part. We also saw plenty of different birds hiding in the trees, and of course, bears are known to make an appearance occasionally as well. This hike is not for the faint of heart, but if you're somebody that enjoys nature, it is one that absolutely needs to be done.

The Surgical Room

On the 4th of February, 2019, I got to watch a total knee replacement.this elective surgery was done on a patient who had severe osteoarthritis and had affectively no Articular cartilage left on the left side of her right knee. I met Dr Atrah in the theatre after changing into scrubs and boots and donning surgical mask and gloves. I helped the performing team gown up and get ready for their surgery. The patient, the lady of about mid 70s, was wheeled to the operating room, anaesthetised from the lumbar spine down. We made brief Eye contact, the drapes were put up to shroud her line of sight (as she was sedated yet conscious), The chlorhexidine was applied to sterilise her right leg, and the first incision was made to open the up and down to the bone.

Throughout the procedure, the would would be drained of blood, and bleeding venules were cauterised. Atrah prefers not to tourniquet the leg, as it causes a huge surge of blood post surgery and could potentially lead to emboli. A few holes were drilled, part of the bone were kept for sizing of the new tibiofemoral joint, Some angled cards were made and rounded off, and after the trial joints were put in place, the plastic patella and shiny steel femoral condyles and tibial head were cemented in place. The doctors gave me some of the excess cement from the joint to hold in my hand, and I felt it both create an exothermic reaction (helps bone regrowth and vascularity) and harden to a rock.

After the procedure, the patient was stitched up, and I was told that she would be able to walk on it tomorrow.the whole procedure was like watching an artisan work in his workshop, a carpenter building the new queen's throne. I was invited to see surgery performed again the following day, and gladly opted to do so. I was treating hip and knee patients as an Occupational Therapy student, and now, I was getting to see the procedures I was treating in real time with real physician and patient interactions.

For the hip surgery on 5/2, i had a quick lunch and straight down to theatre to meet Mr Atrah once more. Per the day prior, there was an airflow machine that cleaned the air of any pathogens, sterile surfaces, debridement and cauterising tools, a liquid drainer, and lots of sterile tools. The lady, previously having her opposite hip done, chose to not have sedation. The leg was draped in an iodine wrap to isolate and prevent infection, and the first incision was made. After severing the gracilis, tensor fascia latae, vastus lateralus, gluteus minimus, and glutus medius, the adipose tissue was separated and the femoral head was found. A bone saw cut the capsule from the trochanteric notch, and the acetabulum was reamed and bored out. The metal insert, after a trial run, was hammered into the acetabulum, followed by the polyethylene socket that emulates articular cartilage.

After this bit, a bit of debridement was done, and the surgeon malleted a wedge into the patient’s intertrochanteric neck to form an opening for the new head of femur (typically steel, chromium, or cobalt) to be inserted with a few more sledgings. I was called over to the surgical table to see the patient’s new, artificial hip flexing, extending, and rotating. Under spinal anaesthesia, the patient could feel these movements, but the sensations were dulled and painless. The severed muscles were stitched back together (they would recover in a few weeks, just as muscles recover post-workout), and the adipose tissue, dermis, and epidermis were sutured back together. Finally, the epidermis was stapled, a bandaged was placed over the area, and I followed the patient back to the recovery room, where she was desperate for a cup of tea (as is the English way, I suppose).

Comparing these two surgeries to another is like comparing oranges to tomatoes – one is a fruit, and one is sort of like a fruit. In both cases, old arthritically affected joints were sawed away, and shiny new metallic/plasticine parts were implanted. In both cases, the patients were anesthetised from the lumbar spine down. Surgical precautions were followed, and I saw a lot of similar tools (save the ones that aligned the knee or hip and allowed for measurement, angling, and/or the actual replacement). The surgeon was happily working his task, the team lead would suture and staple the patient’s affected parts back together, and the surgical assistant was deafeningly busy.

The major differences however lied in the surgical process itself. With the knee, three separate bones - the condylar surfaces, posterior patella, and tibial head - were sawed in places and eventually replaced with metal (save the patella, which was plastic). With the hip, there were only two; the head of the femur and the acetabulum (with it all being metal sans the articular cartilage, which was polyetheline). The hip was much deeper than the femur, and more muscles had to be severed and then stitched together for the surgery to be successful. The knee had to be properly aligned, and the trial process was much more intense. Just as well, knee surgeries typically use cementing, whereas hips do not. I also noticed that a lot more blood and marrow came from the knee operation than the hip, in spite of all of the muscles and fat that were severed.

Comparing surgical theatre between the USA (my homeland) and the UK, theatres in the US were more compact, had more equipment, and had a bigger team of clinicians present. However, in the UK, the infection control process was seemingly stricter. These differences may also very well be a product of the actual operation itself as well: I saw elective surgery in the UK, but the one in the states was done to save a patient’s life (bypassing the Left Anterior Descending artery of the heart using the Left Internal Mammary Artery).

The whole experience was exhilarating, to say the least. Most of my friends consider themselves squeamish; I am quite the opposite, save for a few bodily fluids. The bone cement sort of freaked me out with the exothermic reaction, and I had a few ‘oh my god’ moments under my breath during the procedures – namely when the bone bits started flying.  Being informed of different parts of the surgical process was also very exciting. I wish I had more time to develop and ask more questions; albeit, most were answered during the surgical process.

All in all, I'm very thankful the procedures I've been able to observe. Next up in this process is to learn more about redesigning the home and broadening my clinical knowledge. Catch you all soon!

Kings and Queens of Prussia

Just before visiting my friend in East Greenville, I decided to swing by the King of Prussia area to visit my friend Kelly who lives there. She also went to York with me, before transferring out to go back home to finish undergraduate studies. It was a very quiet little area, but still worth mentioning on here.

My friend lives in a small town called Phoenixville, about 10 minutes from Valley Forge National Park in about 15 minutes from King of Prussia Mall. Valley Forge is a very nice Historic Park, and although I got to drive by it, it was dark out, so I didn't really get to set foot inside the park. It was quite a phenomenal location to visit, as there are lots of trails to hike inside the park and statues and memorials and whatnot. Visiting my friend this summer and getting to swim in her pool with one of her friends was an incredible gift. And now for the main event, King of Prussia.

King of Prussia at the time that I visited it was the second largest strip mall in America. Plans were released to expand the mall completely by 2020, effectively making it the largest mall in America. It has a plethora of stores between three floors, spans 300 yards, and overall is a good place to spend an afternoon and burn some daylight. Many patrons from far and wide to travel to this area to see what this part of Pennsylvania is like, as there's also hotels and lavish casinos nearby.

When I stepped inside the mall for the first time to visit my friend, I walked to the nearest Starbucks, which was bigger than most stand alone stores that I visited. There were a few other stores Incorporated clothing, pop culture, and other things into their store. It is a good place to spend money and find any sort of store imaginable, and I noticed this almost immediately. I met up with my friend and her friend Kim, and we went for a little walk around the mall. We went to Wegmans after that, which was the first Wegmans that I've ever been to. My initial impression? The stores are much bigger out here on the east coast of Pennsylvania.

Although I personally don't spend a whole lot of time in malls because I'm more interested in geographical destinations, you can plainly see that this mall has a lot to offer everybody. I also try to conserve my money as much as possible, so I didn't spend a whole lot of time browsing the stores. No matter what you're into, you can always get exercise and simultaneously shop at King of Prussia.