Access control in a medical VNA

24 Feb

How do you make sure only the right personnel can see the medical media content stored in a VNA (Vendor Neutral Archive) – being sure that the access policies are adhered to, without devoting enormous resources to the task?

The answer is simple, but likely to prove unpopular.

Consider first the EPR (EPJ). There are two checkpoints to clear before a document is displayed to any employee with legitimate access to the EPR:
1) Does the employee have a current care relation with the patient (that the document describes)?
2) if yes, does the employee´s access profile include the category of the document in question?
The 2nd step is also crucial. As an example, a physiotherapist can read documents related to the work he/she carries out, but not the psychiatrist´s assessment, nor other clinical documents. Now, an image is added to the VNA relating to an aspect of the patient that´s outside of the legitimate needs of the physiotherapist How do we make sure the image is hidden from the physio? A modern teaching hospital has about 40 different professions, and maybe 100 document categories linked to the professions by access profiles.

To give you an idea:
As a SOMATIC NURSE you have READ access to somatic and psychiatric documents created by NURSES, and WRITE access to somatic NURSE DOCUMENTS .
There are many more documents you can read, and even more you cannot create or edit.

The employee can read the Document since the role gives access via the profile and the category of the document

So far so good within the EPR. We will now add the VNA to the mix. An image is added to the VNA, in the patient´s folder. We can state with certainty that it is created within a clinical context with a specific purpose; generally the equipment used to capture the image receives some data from the EPR (metadata), that are stored with the image in the VNA (analogous to RIS/PACS workflow). The image shows a bruise related to a fracture caused by violence. The image is described in a journal record in the EPR which also includes remarks about a radiology report.

The question now arises: who should be able to see this image? Here we must make an educated guess about the hospital´s access policy – see below. But first of all, the care relationship must be present. There is only one system that can determine if it is indeed present, and that is the EPR: so, we need to ask the EPR: does employee X have a current care relationship with patient Y? If the answer is yes, the patient folder in the VNA can be displayed. But will the VNA reveal all data about the patient to our employee X? No, it cannot, for the same reason as we have discussed above.

Access to the Image is controlled by access to the linked Document in the EPR

If the image of the bruise captured above relates to a suspected criminal case, the journal record describing the bruise will belong to a specific category (type) to which only certain roles have access. Logically, the image of the bruise can only be revealed to those that can read the related journal record. Hence, the EPR must control which images are shown to whom, at the document level (category level would have been sufficient were it not for the possibility that a single document instance is blocked from a set of individuals by request from the patient).

The simplest way to implement this is to remove direct access to the VNA. An image will only be displayed by opening a record in the EPR, and from there, opening the linked media content in the VNA.

We can allow direct access to the VNA, but this will carry a large cost in the shape of a large number of access requests to the EPR. We see that there must be one-way references from the journal record to the image identifier in the VNA at least; preferably both ways (the image stores the ID of the document).

The conclusion to this article is that the when the VNA is used to store clinical objects, such as images, ECG, video, and so on, it effectively becomes an extension of the EPR.
This is analogous to the way RIS-PACS interact with each other.


Well, what if there are images/objects in the VNA that are not linked to any document in the EPR? This case is very unusual, but a fallback rule saying “doctors only access” would probably suffice to cover it.


The blizzard

16 Feb

The blizzard unleashed its fury in the late afternoon or early evening, as the light was slowly dwindling over the mountains in the west. It was one of those late spring blizzards that appear out of nowhere and blow cold upon the unsuspecting traveller. And upon the expecting bandits.

Shortly after the wind appeared, the snow started to come down in diagonal streaks, and within a short time the ground in the high valleys was covered in white. A shepherd boy heard a couple of shots ring out, and as if by instinct moved to the door of his shack. He peered out through a crack and as he had expected could only make out the land falling away towards the valley below, dimly through the snow. A short while passed, another shot.

The milk in the large black pan was almost at boiling point. He moved it away from the fire, and pulled on his long boots, slid on his heavy leather coat and ditto hat, then the thick leather mittens with their woolen lining. And then he moved out into the cold, wet blizzard and started down the slope at a quick pace. The snow was no more than a few inches thick, but made the ground slippery, and he could feel the cold through the leather, since the snow  stuck to it.

The scene before him as he reached the ford was more or less as he had expected. On either side of the fast-moving stream the terrain rose quite sharply, which meant a slow approach and a similarly slow ascent once on the other side. This gave attackers ample time to choose when to engage; generally as about half the travelling company was across the stream. Just across on the other side a horse lay on its side. A bit further up the shadow of a man was already partly covered in snow. There were footprints from horses scattered around, and here and there he could make out the shapes of belongings; as he approached the ford he stumbled over a saddle pack and then stepped on a pistol. Apart from this, nothing. Or so it seemed. He was the only living creature here, and felt a strange calmness. In any case he was not afraid of bandits. He knew them, and they knew him. He was poor, they were poor. He sometimes gave them milk and cheese in exchange for a coin or some ham. They had their code of honour, and he knew they only fired if they were forced to by the circumstances. Someone must have put up resistance, and then fled.

The shepherd boy crossed the stream and walked the few steps to the dead horse. The snow was melting on its warm fur, and this made the contrast with the half hidden shape next to it even more striking. A human shape was lying there, seemingly trapped by the fallen quadruped. Leaning over, he moved the beautiful embroidered cape aside to reveal the face of a young woman. She was breathing, eyes closed, her right arm under the horse. Her face was white, her lips a bluish tinge. 

Freeing her arm turned out to be quite easy. She had been knocked unconscious by the fall and left by her company as they fled, he figured. A few more hours and she would freeze to death; so he picked her up, hoisted her over his shoulders and made for his shack.

The young woman was lying in his simple bunk. He was sweating from the effort of carrying her up the hill; his legs were burning, his chest heaving. As for her, she was breathing, but in a shallow, laboured fashion, and she was very cold. His shack had stone walls that let the cold wind in, the hearth was the only source of heat. That, the warm milk, and his own body. He decided to make use of the latter two. Gingerly he freed her of her wet clothes, trying to avoid hurting her arm. Soon she was naked. Her long lace underwear was soaked; it had to go, too. In the dim light from the hearth and the one oil lamp, he could make out the shadow of her breasts and the mass of curly hair where her legs met. Not stopping to take it all in, he got a large pan of warm milk and started to rub her down, soaking a large natural sponge with it; it was one of his prized possessions, spoils from a robbery he had witnessed as an even younger man.
Soon he was rubbing her vigorously with the sponge, as hot as he dared, and in doing so he got to know her body well. He rolled her onto her stomach. In the dim light he could see the curves of her hips and feel her firm, round thighs under his hands. The warm milk gave off a strange odour when it dried on her.

The warm milk seemed to bring some life to her skin; she shuddered, moaned. He realized the cold air would undo any good the warm liquid could do, stripped out of his clothes and got in beside her, covering them both with the animal hides he slept under. They kept him warm even in the midst of winter. But she was still frozen. He held her tight; his excess of heat crept slowly into her body, and suddenly her eyes opened.

He was afraid she would start screaming. But instead she started trembling. Her body was finally reacting to the hypothermia and marshalling its own resources. He realised some milk might help and offered her a drink. She managed half of a cup between bouts of trembling.

They lay down, he held her. After an eternity, the trembling subsided, she slid into sleep, he followed her, sleeping fitfully, then deeply. As he woke, sunlight was seeping in through cracks in the walls of dry stone, and he knew that outside the snow was quickly melting, revealing both the beauty and the ugliness of the world.

They were hot now: her skin was warm and smooth and her cheeks rosy. Her face was partly in shade so the sunlight was not threatening to wake her. He realised his member was hard against her soft thigh. How could he resist visiting her body with his hands? With his free hand he felt her soft curves. He dwelt on her breasts for a long time. Such marvels! He was on fire; dimly he knew that he was thirsty and hungry, but most of all he hungered for her. The soft skin of her hand was brushing against his member, then suddenly grasping it firmly, in her sleep. She was surfacing from deep sleep, her hand making jerking movements as it held him. It was all he could do to suppress a moan, then the contractions in his belly, that indescribable, brief sweetness, and his wet fluids on her skin, on the hide below them, on his own belly. She woke.

She woke and kissed him. He had never kissed anyone, and now she rolled onto him and started to press against his lean, muscular thigh, crushing his member below her weight. He was able to put his hand around her soft behind, marvel of marvels. Unafraid he let his hands venture further, to find wetness, softness. Her hand again; this time it knew what it was doing. She squeezed and cajoled him, then, once she was satisfied with the results, she slid him inside of her and started to ride him. She freed herself partly of the hides and rode him slowly, pressing her loins against his, sometimes with a hand between her legs, sometimes not. He was a spectator, an outsider looking into an unknown world, a terrifying world for an innocent young man who spent his days tending the cows in the high fields of the alps. She was growing impatient, she wanted more from his body, she tried different angles and movements. He could feel the wave grow again in his loins, and without warning it burst inside her, and he quickly went limp.

They lay next to each other.

“Ou suis-je”, she said. “Dans les montagnes encore?”

“Si, montagna”. He nodded eagerly.

“Comment tu t´appèles?”

He signalled incomprehension.

“Ton nom. Nome!”

“Mi chiamo Matteo”

“Je suis Cécile.”

“Sei ricca”.

She smiled.

“E bella”, he added to himself.

“mon fiancé – fidanzato – verra me chercher. Cercare”, she said.

“Il croirà que je suis morte”.

She grabbed his hand and put it between her legs. He recoiled as if he had put his hands in hot milk – but she insisted. She showed him how to touch her, gently, firmly, quickly. Once more he felt like an intruder upon a world unknown to him. The sight and sound and smell of her roused him, he wanted to be one with her once more, the last time, he knew, and threw himself on top of her, driven by an instinct he had never known. It was a wild ride. He had to ride her hard to reach his climax, and she egged him on, she met him. They were one in this.

And then it was over, and they were sweaty, and she was awkward in borrowed clothes that smelt of him and animals, while her garments were drying in the sun. They had breakfast on his simple foods, not speaking beyond simple words they could both understand. 

She had barely got dressed in her own, damp clothes when a trumpet rang out in the valley below, and a short while later a gaggle of horsemen appeared over the crest of the meadow below the shack. The young woman ran down to meet them, having recognized the colours of her fiancé´s coat-of-arms and the standards fluttering in the breeze behind the armed men at his side.

The shepherd boy kept to his shack. As he stood in the doorway he witnessed Cécile reach the men. They spoke for a while, she pointed in his direction. He heard the angry voice of the lead man – he must be her fiancé. Having fled in panic he was back to see what had become of his bride-to-be.Presently Cécile mounted the horse behind her man, and the whole group set in motion and quickly covered the hundred yards or so to the shepherd´s shack. The shepherd bowed before the man on the first horse, who was dressed in his finest horseman´s outfit and clearly belonged to the nobility. This man, Cécile´s fidanzato, looked the shepherd up and down, down and up. He gave a grunt and a short command to one of his men, who came up to the front and tossed a coin to the shepherd. Then they swung their horses around as one, and cantered away down the meadow, Cécile not once looking back.

RAV4 4wd Hybrid 2016 second hand

24 Jan

Some quick notes on the ownership experience.

We bought the car 2016-model when it was 3 years old and had 90.000 km on the clock. It´s an Active S, meaning leather, powered driver´s seat, rear camera, driver assistance systems.

It´s a Toyota, so 2 years in and about 30.000 km we have not had any unexpected expenses. The drivetrain is bullet-proof. First set of front discs just wore out at 125.000.

The car is 4WD on demand, with an electric motor living all alone at the rear driving the rear wheels. This motor is also a generator and participates in energy recuperation. The front wheels are driven by the 150HP petrol engine and a separate electric motor – or two, actually: https://en.wikipedia.org/wiki/Hybrid_Synergy_Drive. Quiet, linear acceleration.

Aspects to consider:

  • Space is good. 5 adults can ride in the back, 4 very comfortably. Lots of leg room
  • Decent 500 litre boot with strange hump in floor due to battery intruding
  • Excruciatingly slow powered tailgate
  • Very very comfortable and very silent running. Love the soft suspension, avoids the sea-sickness of old Volvo XC70s
  • Rolls a bit in corners
  • Good acceleration but you have to really ask for it
  • Conti W7 (nordic) studless / friction tyres fantastic
  • Dunlop Sport Maxx RT2 for the summer. Much less noisy than standard tyres, very very comfortable (235/55 R18). Highly recommended
  • Four wheel drive excellent in middle to quite hard conditions: car feels planted and goes hard, needn´t worry when parking in snow and rough ice
  • Four wheel drive 100% useless when you really need it: ice and slight uphill from standstill, computer sends zero power to rear wheels, no selective braking of spinning front wheel. Nada. As ineffective as a FWD Yaris. Really disappointing. Seriously, Toyota! A few lines of code and you could get the car moving.
  • The whole instrumentation etc smacks of 2001. The various systems are clearly not talking when the parking sensors start to complain at 100km/h because they are covered in slush. When you change wheel-set (winter/summer) you have to reset the tyre pressure sensor via a dedicated button hidden on the steering column. C´mon, c´mon, Toyota! I call Toyota twice a year to have them tell me how to do this, the instruction booklet has in inaccurate description. The EV button has no impact on anything. The manual selection of “gears” is there, but no-one ever uses it. So – if you´re hooked on the future, this is not for you. This is the past in terms of systems architecture
  • Connecting phones via Bluetooth is reliable but infuriating. Well hidden, and max 4 phones at a time… what on earth?
  • Fuel economy: computer says about 6.5/100 in summer, 7.5-8.0 in winter. The combustion engine runs a lot in winter just to keep occupants warm. Takes a while to heat the cabin – efficient engine gives off less heat. I always leave it in ECO- mode. Switch off ECO for more throttle response and more thirst. Switch to SPORT for …nothing!. Switch back to ECO.
  • Towing capacity ot 1650 kg nice to have
  • If you want a spacious, affordable, comfortable, reliable, 4WD that´s cheap to run and own and keeps its value, runs on petrol, and you rarely venture onto hills covered in ice, this it the car for you.
  • When you get stuck, slap on snowchains in 3 minutes, and off you go


Surfski for the newbie: Epic V10L and Carbonology Boost

19 Oct

And so it came to pass that I was given a secondhand V10L for my birthday, and I have spent a fair bit of time in it, and also some time out of it… this is my first full season in a kayak, and the 44 cms of support for your clumsiness that the V10L provides is sometimes not enough, and I have been in the water many a time. But I am improving, I am…

Our hero surrounded by obsolete technology

I have used it on the flat, on the somewhat choppy, and on the ocean. The ocean was a bit too much, the rest I can just about manage, though there are many heart-in-mouth-moments.

When I first got into the V10L all went well; and so I bought it.

The next trip I fell in immediately and couldn´t get back in. This was 15 metres from the quayside, and my kids were witness to my failed attempts.

One or two Youtube videos later – “surfski remount” – and all was well. I can get back in. Once in, I lean back in the seat until things quieten down, and then I set off. The added adrenalin gives the drive to move the boat; it´s far more stable on the move.

I bought an NRS 0.5mm wetsuit of the long-John type with no arms. On top of this I sometimes wear a thin wool underwear thingy. This works well, but I will probably get an NRS vest next season for colder days.

I bought a secondhand Bracia paddle, adjustable & all. I kept it screwed together for a month in and out of salt water, and now it´s impossible to budge.

The desire to challenge myself and the elements is always there – but in order to challenge the ocean outside Tvedestrand, I have ordered a Carbonology Sports Boost LV. I have been on the open ocean in “interesting” conditions once, that was in an Epic V7. The V7 felt very stable, and I only fell in three times (!).

Surfski and Kayak has opened up a new chapter alongside rowing, and I am working on technique and strength – thanks again to Youtube!

Stuff I should read

13 Aug

E.R Braithwaite To Sir, with love

Kershaw on Hitler, The Rise and Fall of the Third Reich

The Crimean war

The Ratline (Sand)

L´ordre du jour

Samtidsdrama

5 May

Eg kobla meg opp mot labradoren med ei lærreim og gjekk ned trappa. Eg logga meg ut gjennom utgangsdøra og steig ut på gata. Det var stilt ute. Eg trakk i reima. «Kom no, Online», sa eg, og satte kursen mot parken.

Kona mi hadde straks gått for forslaget mitt om å ta hunden ut ein tur. Vi gjekk ikkje tur saman meir pr. idag. Kommunikasjonen mot kona var eigentleg inne i ein down-periode, hadde eg funne ut.

Bikkja kom med eit innspill: ho ville bort til eit tre. Eg ga henne aksept på det, og ho gjorde ein release mot trestamma.

Vi tusla vidare. Borte ved gate’n til parken sto ein mann og supporta seg på ein stokk. Han såg litt trøytt ut. Kanhende fekk ikkje han heller nok oppbacking heime?

Det var kaldt og eg følte for å avslutte sesjonen ute. Det var verkeleg mykje overhead med denne bikkja. Kanhende skulle eg avslutte leasingavtalen hennar, sjølv om det stod att eit år ? Nei, ho var jo så søt. Og no som kona…. Nei, best å ikkje kome inn i ein loop av tunge tankar.

Eg ruta meg heim att. Kona var ute då eg kom inn. Eg visste at ho hadde outsourca somme tenester som eg hadde vore supplier for tidlegare. Kanhende hadde den nye kortare turnaround tid, tenkte eg resignert.

Eg knytta meg opp mot ein site i USA og downloada ein cyberburgar. Eg tok meg ein byte.

Weather report

1 May

Det var en uke siden det hele var over. De siste krampetrekningene av russefeiringen var allerede kun et blekt minne bak videregående eksamens tykke gardin da de siste vitnemål, de siste klemmer, de siste lykkeønskninger og de siste “ses snart” ble delt ut.

Faglærer med lektorkompetanse Nils Sønderlev kunne se frem til åtte uker med fri fra daglig kontakt med søtten-atten-nittenåringene, fra evalueringer, lekseretting, planlegging, elevsamtaler, koordineringsmøter, pulverkaffe og nøkkelost. Skjønt, nøkkelost kunne han holde frem med, men han kunne i alle fall nyte en skikkelig kopp kaffe til den der han satt i sin åpne kjøkkenløsning og så ut på bølgene som rullet mot stranden. Mellom huset hans og stranden gikk en smal grusvei rammet inn av høyt, ujevnt grøftegress, og annen vegetasjon enn stritt gress var det ikke å se på denne siden av huset. Innover land, på lé side, vokste en lav glissen skog i den sandrike jorden.

Nils bladde distré i lektorlagets månedsblad. Han merket at det han leste ikke gikk inn. Han var for rastløs. Han var rett og slett rastløs! Tiden gikk sakte, sto nærmest stille. Det var to uker til han skulle overta ungene fra Birte, og han hadde ikke planlagt noe for denne mellomperioden under den feilaktige antagelsen at hvile ville være godt etter året som var gått, som hadde blitt innledet med skilsmisse og siden hadde vært anstrengende på de aller fleste fronter.

I løpet av uken som var gått hadde han hatt rikelig tid til å tenke over sin nye situasjon, og denne hadde på merkelig vis blitt mye mer tydelig for ham nå som den daglige rutinen var brutt opp. Fraværet av hektisk hverdag lot det hele tre fram med klare konturer. Nyskilt. 41. To barn som bodde hos Gitte. Lite hus på stranden. Lektor i matte i videregående. Seksuelt og følelsesmessig frustrert. Konflikt med rektor og inspektør. Avstandsforelsket i Marianne, 19 år og én måned.

Det siste var en dårlig bevoktet hemmelighet, men det var ikke årsaken til at han var skilt. Ekteskapet hadde vært på randen av sammenbrudd i mange år, og det måtte gå galt før eller siden. Alt som manglet var en utløsende faktor, et skudd i Sarajevo. Det trengte ikke være et skudd en gang, en sprettert ville kunne være nok om den traff rett. Da konflikten på skolen toppet seg og Nils ble enda mer gretten hjemme og rektor møtte Birte på kroen og de drakk seg til gode venninner og rektor la ut om hva Nils hadde sagt og gjort, da rullet ballen, og den lot seg ikke stoppe. Ingen av dem ønsket heller å stoppe den, men Nils fikk den lille seieren det var at det var Birte som til slutt sa “stopp” og hev ham ut. Hun kunne ikke være gift med en sånn mann lenger, og var han ikke forelsket i hun der i anden gym? Knapt nok myndig!

Forelsket eller ikke, det visste Nils knapt selv, han hadde sett så mange nydelige piker opp gjennom årene fra plassen bak kateteret, og den intimiteten som lå i lærer-rollen, og den avstanden som den også innebar, hadde den virkningen på ham at spørsmålet om tiltrekning ble underordnet. Den var der eller ikke, som en naturkraft, han registrerte det, fokuserte så på oppgavene. Men han hadde sikkert glodd på henne i et øyeblikk da alle satt og regnet, og så blitt overrasket av et løftet blikk fra henne, og rødmet. Det hadde han sikkert. Noen kunne jo ha sett det.

Uansett var hun kjæreste med Fillip i parallellklassen, hva hun så i ham var ikke godt å si, og hvis hun kunne like Fillip så godt, var hun neppe noe å samle på in the first place. Fillip. En streber. Greit begavet, javel, fra en god familie, penger nok, good-looking. Velkledd. Fagkrets som pekte i retning av jus eller finans – jobb i the city. Marianne var så mye mer enn det! Nils hadde henne i matte, best i klassen med god margin, og han visste at hun hadde stor bredde, god i språk, i samfunnsfag, i gym! Hun var en god mellomdistanseløper, ville knust ham på 3000 meter, det var han sikker på. Elevrådsleder i andre og tredje, satt i samarbeidsutvalget. Nils hadde møtt henne der hver måned i ett år. Ting ble ikke bedre av det.

I samfunnsfag hadde de hatt et prosjekt om sosiale medier, og derfor var de blitt venner på Facebook. Kunne eller burde elever og lærere være venner på Face? Konklusjonen ble visst nei. Siden hadde hun glemt, eller i alle fall latt være, å stryke ham fra vennelisten, og dermed kunne han følge med i livet hennes uten at det ble for tydelig. Han stalket henne i det stille. Dermed visste han før mange at det ble slutt med Fillip i eksamensperioden. Trøstemeldingene haglet inn på Face. “leit da :-(“ osv. Han fikk lyst til å skrive “sannelig på tide” men holdt seg fra det.

Denne formiddagen, da han bladde i lektorenes månedsblad, populært kalt “klagemuren”, tenkte han en del på nettopp Marianne. Han hadde sett henne senest i går. Overraskende nok var hun hjemme – tydeligvis, i og med at han løp på henne da han var ute og jogget. De møttes på den smale stien noen kilometer fra hans eget hus, og utvekslet bare et “hei”. Han løp videre med en tung følelse i magen, et sug, han skulle ha snakket mer med henne! Men det hadde kommet så brått, stien gjorde en sving rundt et lagerbygg av betong helt nede ved sjøen. Plutselig var hun der, så var hun forbi. Skitt! Hvis de hadde møttes i åpent lende, og han hadde fått tid til å forberede seg, så kunne de slått av en prat!
Så snart han kom hjem sjekket Nils Facebook. Etter litt leting kom han til roten til hennes nærvær her i den søvnige hjembyen: charterselskapet hun skulle vært på Kos med hadde gått konkurs dagen før hun skulle reise. Facebooksiden deres var nå satt passiv, men en rekke mishagsytringer kunne ennå leses fra de dagene kommunikasjonsstaben hadde forsøkt å holde fortet på Facebook, og Marianne hadde vært inne og “liket” en melding eller to. Deretter trøstet hun og venninnen Lise hverandre og lovet at de skulle ta det igjen en annen gang.

Nils ryddet bort nøkkelosten og helte i seg den siste kaffen. Han tittet ut. Været var i ferd med å slå om. Fra solskinn og et par og tyve pluss forverret været seg foran øynene hans. En tykk sort byge kom rullende inn, slukte solen, pisket opp sjøen, og sendte termometeret ned i femten grader. Så kom regnet og deretter en haglbyge. Langs stien kom en skikkelse joggende, nei, løpende, i shorts og t-skjorte. Vedkommende var gjennomvåt, det var det ingen tvil om. Konturene var lite tydelige gjennom regnet, og verandadøren var full av regndråper som begrenset sikten. Skikkelsen brøt av fra stien, løp gjennom porten i gjerdet, og kom rett mot Nils. Det var Marianne. I neste nu banket hun på verandadøren, dro selv i håndtaket og skjøv døren til side, og kom inn. Marianne sto foran ham, våt til skinnet. Brystvortene var særdeles tydelige gjennom en hvit t-skjorte, de blå løpeshortsene hennes var trange fra før og klebet seg til huden. En ange av regn og vaskemiddel sto om henne, det våte håret hennes luktet sjampo. En dam vokste rundt skoene hennes. Hun så den. “Unnskyld”, utbrøt hun, det kom en byge og jeg ble så kald, og så husket jeg at du bor her.

Husket, tenkte Nils.

“Det gjør ingenting”. Hun hadde gåsehud.

“Du trenger en varm dusj.”

Å, intimiteten! Hun vred av seg skoene og sokkene og satte dem ut på verandaen, en manøver som ga ham plenty mulighet til å studere lårene hennes, senene på innsiden av knærne, leggene, føttene (str 38?), formen på enden hennes, nakken over t-skjorten.

Så trippet hun inn fra vinterhaven, inn i gangen der han pekte, og inn på badet.

“Du finner et håndkle i skapet til venstre”

Så var hun borte, lukket inne, han hørte vannet renne, visste at hun sto helt naken der noen ganske få meter fra ham, og det føltes som mange mil. Han kunne ikke godt gå inn og dusje med henne.

Eller kunne han?

Så aggressiv var han tross alt ikke.

I stedet hentet han tøy inne på soverommet. Det var mer som en alkove, delt av fra vinterhaven/stuen med en bokhylle fra gulv til tak og et tykt forheng som holdt ute besøkendes blikk og morgenlyset. I en nettingkurv fant han et sett treningstøy – bukser og langermet skjorte i myk bomull. Truser? Det fantes ikke.

Utenfor badedøren stoppet han. Vannet rant. Han åpnet døren på gløtt, la tøyet inn, ropte “her er noe tøy”, og gikk og satte på tevann. Han ventet. Vannet sluttet å renne på badet. Tevannet kokte. Hun kom ut av badet med håndkleet hans rundt hodet, iført hans treningsdrakt. Den var for stor, men ikke mye. Han visste hun var naken under, og at hun kunne kjenne bomullstoffet mot enden og mot brystene, og en naken følelse i skrittet siden det ikke var noe stoff som klemte mot huden og hindret luften i å sirkulere. Hun så på ham, og leste tankene hans, det var han sikker på.

Han rakte henne et tekrus uten å si noe, og bladde i en spilleliste på iPaden. En berøring av glassflaten, og så kom Weather Report ut av en høyttaler i bokhyllen.

“Er ikke du mer typen til platespiller”, spurte hun ertende.

“Den er til reparasjon”, svarte han.

Hun ble usikker.

“Du tuller!”.

Uten å si noe gikk han bort til bokhyllen og begynte å bla i en en rekke LPer som stod nederst. Han kom tilbake til henne og ga henne en LP med Weather Report.

“Det er denne vi hører på”

“Den er ikke noe å danse til”

Hun så direkte på ham over tekoppen. Munnen var skjult. Blikket var lurt.

“Så la oss hoppe over dansingen”, tenkte han.

“Så la oss hoppe over dansingen”, hørte han en stemme si. Det var hans egen.

Hun satt på en høy krakk ved den lange brede platen som var spiseplass. Han stod tvers over for henne, og nå gikk hun de to skrittene rundt den avrundede enden av platen og kom bort til ham. Uten videre la hun armene rundt ham og kysset ham.

De kysset hverandre forsiktig, undrende, tørt, prøvende. Øynene hennes var rett i hans, håret hennes var vått og fuktet dem begge. Hun luktet friskt, og han var urolig for at han luktet gammel geit.

Hun la nesen inn mot halsen hans.

“Du lukter godt”

Han trodde henne, og kysset henne med mer kraft. Hendene hans holdt henne fast, søkte inn under skjorten til den bare glatte huden på hennes korsrygg. Hun var slank. Han ble svimmel av glede. Han åpnet en propp og lot verden renne ned i avløpet, alt som fantes nå var hennes svale, myke rygg og stadig varmere lepper og pust. Han kunne ikke la være å føre hendene ned under strikken i buksene hennes – som var hans  – og stryke den myke enden hennes. Hun lå, hang, sto helt inntil ham, kyss på kyss. Det var satans godt å kysse henne, kåtheten brant i ham, lå hard og tydelig mellom dem. Hun flyttet seg litt sideveis og gned seg mot låret hans, sukket litt.

Hva nå? Ville hun elske med ham? På ordentlig? Hva med prevensjon? Han hadde nok med de to han hadde … skulle han bare komme inn i henne her, stående, dyrisk? Han hadde spørsmål som bare hun kunne svare på.

“jeg er på pillen fortsatt”, sa hun lavt. Nils hørte referansen til Fillips penis, men klarte å skyve den unna, godt hjulpet av hennes neste trekk. Hun vrikket seg ut av treningsbuksens ene ben uten å slippe ham for mye, så løftet hun høyre ben og støttet det mot den horisontale avstiveren som knyttet sammen de fire bena på den høye kjøkkenkrakken. Hun lente seg bakover og skjøv underlivet fram, grep lemmet hans og styrte det mot åpningen sin. Nils knakk litt i knærne for å komme lavt nok og søkte den rette vinkelen med hoftene. Han begynte å presse mot henne. Det buttet i mot. Fingrene hennes var der og hjalp til. Au – hun var uforsiktig med en spiss negl. Der! Nå var han på rett plass og begynte å lirke seg inn i henne. Blikket hennes var der, rett i hans. Hendene bak rompen hans – buksene hans var bare såvidt nedenfor enden. Men en jevn bevegelse klemte han seg helt inn i henne, fikk rettet bena litt, lårene verket. Det sprengte på noe helt vanvittig, en panikkartet følelse spredde seg i ham. Nei, ikke nå! Han støtte inn og ut av henne noen ganger til, så visste han at han var over tippepunktet. Orgasmen kom deretter lynfort. Nærhet og romantikk vek plassen for en flom av væske, han kom og kom og kom, det var som han skulle revne. Hun så på ham, en viss distanse nå, eller moderlig medynk, det blikket kvinner har når de tar i mot alt hvad han har givet etter først å ha sluppet dem inn, latt dem synke mot, inn, i sine varme skjød. Søte, rare menn, så ivrige, og så mister de kontrollen, og så er det over, og de er glade, takknemlige, som valper som har fått en overdose melk.

Hun holdt ham rundt hodet.

“har du lengtet sånn etter meg”

Hun hadde ment det som en spøk, men i det samme hun sa det, mens hun sa det, endret ordene innhold og ble fylt av alvor.

Nils begynte å gråte. Han kjente at her var det mye gråt på lager, så han klemte av før det utartet. Han smilte gjennom tårene.

“ja, jeg har lengtet”.

Han frigjorde seg, korken glapp ut og det rant ut av henne, rett ned på gulvet. Hun fniste. “dagen for de våte gulv!”

Han sa ikke noe, tok henne i hånden, dro eller leide henne inn i sengen, hun satte seg lydig ned og han vrengte av henne toppen og begynte å kysse ryggen hennes, nakken, brystene, magen, lårene. Han var i en merkelig sinnstilstand, kåt, salig, på gråten. Nullstilt. Hun var like deilig som han hadde drømt om, og han måtte erkjenne at han hadde drømt. Han kjente lårene hennes allerede, knehasene, enden. Til og med kjønnet virket velkjent, glatt, trimmet, vått av henne, vått av ham. Han fikk slikke henne litt, men hun ble ensom, dro ham til seg, kysset ham.

“ble du ensom?”

Han gikk og hentet tekoppen hennes, ennå godt lunken, nesten varm. Hans opplevelse av tid var tydeligvis forskjellig fra naturens. Han kjente blikket hennes på ham da han gikk over gulvet, begge veier. Det gjorde ham ingenting – ingen hadde noe å utsette på det de så, enten det var bakfra eller forfra. Birte hadde ofte anklaget ham for ekshibisjonisme, en anklage han selvsagt avviste, og som like selvsagt var fullstendig berettiget.

De satt i sengen og drakk av den samme tekoppen, dekket av et tynt laken.

Kyssene smakte te.

“La meg vise deg et triks”, sa Nils.

Han la en hånd mellom lårene hennes, kjønnet hennes var deilig oppsvulmet og glatt, han avholdt seg fra å hviske noen vulgære ord i øret hennes. Han masserte henne over hele kjønnet og øverst på lårene, kjente at hun reagerte, zoomet inn på området øverst, rett under der leppene møtes, og masserte det. Det virket, hun nøt det. “fortere” hvisket hun. Han gned henne fortere og fortere. Måten hun reagerte på fortalte ham at dette var velkjent terreng for henne. Hun ga seg hen og lot ham ta henne helt inn til klimaks, et klimaks som varte og varte, hele kroppen hennes stod i spenn, ansiktet som en grimase. Så skjøv hun hånden hans vekk – det gjorde visst vondt – og smilte, litt glad, litt brydd.

Han kysset henne på kinnet.

“ingen kommentar”, smilte han.

“mr seen it all before, hva?”

“noe sånt. Noe skal man vel ha for å være … “ han ville ikke si “gammel.”

“erfaren” foreslo hun.

“Nettopp. Erfaren”

Han lurte på om Marianne var like bevisst aldersforskjellen som han var.

En stund til lå de der og han strøk henne lett over hele kroppen. Det var deilig meditativt. Regnet hadde stoppet for lenge siden, og solen lyste opp huden hennes og varmet den.

“jeg går nå”, sa hun rolig.

Hun kledde på seg det våte løpetøyet og våte sko, og skjøv verandadøren opp. Ute dampet det fra bakken, solen brant som om den ville unnskylde seg for pausen litt tidligere, og det var ingen fare for å fryse.

Nils så etter henne der hun løp nedover stien, sørover langs stranden. Som en gaselle, tenkte han.

Da han skrudde av musikken kom lokalnyhetene opp på iPaden.

“Det varslede tordenværet lørdag formiddag slo til med enda større styrke enn antatt. To biler skadet av veltet tre i kommunesenteret”.

 

Spilleliste

8 Mar

Susanne Sundfør: The Brothel + alt annet

Billie Holiday: Strange Fruit

David Bowie: Ashes to ashes

Miles Davis: Time after time

J.S. Bach: Ehre sei dir, Gott, gesungen! (Spotify)

Sia/David Guetta: Flames

Jessie J: Price tag

Michael Kiwanuka: Cold little heart

Marillion: Kayleigh

Eminem: Without me

Bøker:

Master and Margarita (Bulgakov), Pan (Hamsun)

AKSON varslet katastrofe

1 Feb

Et samlet IT-Norge er kritiske til AKSON-prosjektet, eller med andre ord “ikke gjør det på denne måten”.

Likevel turer Direktoratet for e-helse frem.

KS støtter Direktoratet. Men etterpå er det langt mellom støttespillerne.

Næringspolitisk er det vanskelig å forstå tilnærmingen, som med stor sannsynlighet vil ende opp med å favorisere én stor utenlandsk aktør.

Fra ståstedet til IKT-arkitektur er det liten støtte å hente. Alle tilsvarende prosjekter har feilet internasjonalt. 100%. Hvis pasienten dør av behandlingen, må den avsluttes. Medisinen må seponeres når dødeligheten er så høy som dette.

Diagnosen av pasienten er overflatisk. Han har det vondt, klager over smerter her og der. Bandasjen gnager, sier han. Eller mangler helt og holdent. Løsningen: en bandasje som dekker alle behov. Alle. En magisk bandasje. Hvordan denne skal se ut, eller hvori magien ligger, kan ikke Direktoratet svare på.

Det vi upresist kaller “Journal” er et produksjonssystem som må være tilrettelagt for lokale forhold.  Den medisinske delen (pasientjournalen/EPJ) er forsvinnende liten sett ved siden av logistikk, økonomi, organisasjonsstruktur og roller; roller som varierer  avhengig av organisering.

TIlgangsstyring vil bli kritisk og er tett knyttet til profesjoner, organisatorisk tilhørighet og turnus, og det siste betyr at turnusssystemer må integreres. Så har vi allehånde brevmaler, lokale integrasjoner, osv.

“EPJ” er bare en liten del av dette, “PAS”-delen dominerer fullstendig.

Den snakker ingen om.

AKSON kan best forstås sosiologisk og økonomisk.

– KS trenger økonomisk bistand og politisk bistand fordi de har underinvestert på området og leverandørmarkedet reflekterer dette (mikroskopisk, amatørmessig).

– Direktoratet for e-helse forsvarer sin posisjon og eksistensberettigelse og store budsjetter

– Departementet? Aner virkelig ikke. Snodig at Høyre som er næringslivspartiet vil nedlegge hele den norske helse-IT-bransjen.

Checkpoint by Sidsel Wold (Palestine)

29 Dec

This is a resumé of Sidsel Wold´s book from 2006 published in Norwegian by Gyldendal.

Sidsel Wold has been the correspondent for the Norwegian Broadcasting corporation (NRK) in the Middle East for many years. The NRK cherishes its neutrality, but what does a correspondent do when injustice stares her in the face and she is on a sabbatical from her job?

Maybe she writes a book about her stay in Jerusalem. She writes from up close. You can smell the streets, see the flesh from the suicide bombers, smell the smoke from the water pipes and feel the November rain; you can see the living rooms, the tea-cups and the veiled girls…

Checkpoint takes its name from the many checkpoints that break up the daily lives of Palestinians, and ensures that the different Palestinian societies remain apart. To live in Gaza, or a refugee camp on the West Bank, or in a Palestinian-controlled part of the West Bank, or in Tel Aviv with an Israeli passport – these are completely different realities.

Gaza is hell on earth – and this was 2006! The main topic there seems to be death and martyrdom, and the murderous, blind violence meted out by Israel – or shall we call it the Zionist state?

The book makes a few points very clear that are familiar to those that know Israel, briefly summarised:

  • the settler invasion by the Zionists was well organised and well funded
  • the will to displace the indigenous population was there from the start
  • the Palestinians were ill equipped to withstand the onslaught, which essentially pitted the first world against the third world
  • the campaign to squeeze the arabs has gone on relentlessly since 1948
  • after the second Intifada the Wall came up, and security returned to Israel. With it, the will to make a meaningful peace with the Palestinians disappeared. They also disappeared

Wold brings a lot of nuance to our understanding of Israel, with its immigrant populations from myriad countries. It is criss-crossed by sectarian and social fault lines, but unified in its loyalty to the Israeli state. As an example, the rise of Likud is tightly linked with the rise of the political power of the Jews of Arab origin (sephardim, mizrahim) who had been held down by the Askhenazi Jews of European descent (those that spoke Yiddisch).

A few more points are worth mentioning, like the role of religion and tradition. For the Palestinians, religion and tradition often mean a patriarchical society where a womans´s destiny is to bear children and obey her husband. The theme is drearily familiar. It is hard to see how emancipation will take place in a situation where men are oppressed and locked into their roles as breadwinners and fighters. With the demise of the PLO and the rise of Hamas, the space for secular social  politics is limited.

On the Jewish side of the fence, religion also plays a central role, both as provider of identity for all Jews, and as a provider of destiny for religious settlers and the Orthodox. Both these groups seem to inhabit a universe where reason cannot penetrate.

It is often overlooked that about 1.2 million non-jews, mainly muslim arabs, carry an Israeli passport. They enjoy far more freedom than their relatives (figuratively and literally) in the West Bank and Gaza. But they are now wanted. They are not Jews, after all, and this “Nationality” is known by the state and has a huge effect on your prospects in Israel. Whether you are a Jew or not, is a question only the rabbis can decide (Wold does not state this latter fact anywhere, but Shlomo Sand has a lot to say on the issue of Israeli identity politics). And as unwanted citizens, they are discriminated against. Simply put, this is apartheid. One set of rights for me, one for the others. In this case the other is the Goy.

Sidsel Wold uses her skill and charm to connect with Jew and Palestinian, and she has the sensitivity and non-judgmental attitude which allows her to make meaningful connections with people and observations about life in Israel. And yet – her blood boils at the checkpoints.

“As I stand in line, I spot an elderly Palestinian in a green jacket and checkered keffiyeh on the other side of the road. He´s trying to move south on the West Bank. Clearly he was born long before the state of Israel saw the light of day. Two Israeli soldiers, a man and a woman, stop him. The old man gesticulates and tries to talk his way through the control post. A third soldier, sitting smoking on a concrete block with his legs crossed, looks the old man up and down.

– what, won´t they let you through? says the soldier and smiles mockingly. He´s enjoying himself. As always when I am upset, I put on my dark sunglasses. The female IDF soldier lights a smoke and leans into the concrete block.
– but I pass through here every day, says the Palestinian with mounting desperation
– “but I pass through here every day”, repeats the soldier and laughs out loud
– so, you´re here every day? That doesn´t mean you will get through today, you know! says the soldier teasingly. He looks at his colleagues, and they all laugh. The old man turns around slowly and starts on the long journey back.” (page 189)

This episode says it all, really. Occupation destroys the soul of the occupier. It´s about as far from the Jewish spirit as one can get.