4 Months and a Lot to Tell

It has been 4 months since I last posted. Dr Merck was not the anesthesiologist for the bunionectomy. The recovery took 4 weeks longer than I anticipated, and I certainly did not anticipate being non-weight-bearing and on crutches for a full 6 weeks. My family had 2 gatherings however, for Thanksgiving and Christmas. Then my father died on January 14th. I am back to working full-time on the cardiac special care unit. There is a lot to write about. I wish I could write about my patients too, but I am limited to my own experiences. Today I went to an inservice on lipid management in cardiac patients; and again a particular medication was being promoted. The drug class of statins was being promoted as a whole. It was not drug reps promoting it for a change. I have been thinking much on my career and where it is leading me to. I’m on a 7-day stretch, day 3 going on 4. I have been asked to do a double on day 5 to boot. I have to get up at 4am, and it is now nearly 10:40pm. The 4 extra weeks off, plus car trouble have me playing financial catch-up. I miss my family. I need to keep this blog going though. It is important. It is important to evaluate the personal impact of the healthcare system on an individual. It seems nearly a religion at times.

Child Cold Medicine

Finally some sanity. Coworkers (nurses) medicate their babies with Benedryl in order to get adult sleep. It has been recommended by well-intending mothers in yahoo groups; even suggested on some blogs that sleepless parents do this. What the FDA is addressing is the fact that many, many people overuse or misuse cold medication, not just for sleep, but out of ignorance and selfishness.

 Then there are those like my ex-husband’s wife. Every other weekend when the 3 children came home from their three-day visit, along with them came stories of illness due to my neglect, and a cache of medications they’d been given over the weekend that I was to continue. Before long, my cupboard was full of unused Dimatapp, Robitussin, Claritin, Traminic and everything else that could be bought, with instructions to give my children in combinations that I felt might make smoke rise from their heads. I’m a natural remedy sort of person. As a nurse, I have always distrusted over-the-counter cold remedies. Like every other drug, they have side effects. As a medical assistant, the stepmother of my children was a pusher of office samples, brainwashed by drug reps.

Never mind that one son had allergies to tree pollens and animal dander, nor that the best way to avoid infection was to suppress or avoid his allergic reaction, not feed him decongestants too much too late. Never mind the bags of candy that came back with the cache of medicines. Never mind their highly refined-food diet that also happened to make them very constipated during any length of stay. They sent me candy – I sent them fruit.

Sleepytime tea is sold as a food item. It has remedies in it that have been used for centuries – chamomile and mint. A mildly sweetened cup of warm tea, a book, and a song or two on the guitar put my children to sleep just as well as diphenhydramine (the active ingredient in Benedryl), only my routine had the added benefit of “quality time” spent with my children each night. Chamomile and mint have never been recalled by the FDA. They have never been questioned for use in infants. Mint may even be a galactogogue (increasing mother’s milk production), and may make the breast milk taste better to the baby. Licorice and fennel are also. 20 years later, my children still like to have a relaxing cup of herbal tea with me, which I consider to be a much nicer tradition than a teaspoon and a medicine bottle.

What happened to the old ways of doing things? Sometime in the early 20th century, people in the U.S. got addicted to the teaspoon and a bottle of medicine. In the early 21st century, the FDA is now saying, “That doesn’t work.” Hurray!

Bunionectomy

Wednesday I am having a bunionectomy. It will be in the outpatient center where I had the first blue mole removed, under general anesthesia. I will be off work for at least 5 weeks, so maybe I will devote more time to this blog.

 I wonder if Dr. Merck will be my anesthesiologist again. I wonder if my old coworker, Lisa will be there. There is more to come on this.

Hospice

My father has hospice care. Mother had gotten attatched to the home care people. It was hard to change. Really, there is a lot more to write in the saga of my father’s stroke, but I became very distracted and disillusioned with it all. There are many, many issues I want to write about. Right now, I will just say that hospice is the best choice we’ve made so far. He has settled into a routine of listening to books on tape. The volunteer who sits with him for respite turned out to be an ex-boyfriend’s uncle; an ex-boyfriend my father loved.  The yo-yo between hospitalizations and home got to be too much for all of us. Hospice has changed that.

At work, I have had a few situations where I was able to refer other families to hospice. I made some waves, but I am glad I did it. There is a point where you have to stop trying to save people; and need to let them die with grace, and most acute care nurses don’t know when that point is. I’ve taken a little heat for pushing the issue, but I actually feel very good; very empowered about it all.

Blue Mole Missed Twice

I don’t remember the date of my blue mole surgery. Wait. I’ll look on my calander. It was August 29th. It isn’t healed yet, because, well, she missed it, and I keep trying to get it out with a sewing needle. I think some of my coworkers have noticed about it not healing. A nurse practitioner told me that I need to call the plastic surgeon back and tell her that she missed the mole. That the reason the biopsy report said “overactive sebaceous gland” is that the mole is still on my nose. I just keep thinking – it is right there – I can get it out myself. But it is October, and the tip of my nose is sore. I think I’ll call her tomorrow.

MRSA, Handwashing and Hygiene

30 seconds is the amount of time it takes to wash hands. Lets say I have 4 patients in a given 8 hour shift, and I enter the room an average of 10 times per shift. This is realistic, because we have something called hourly rounding. The aid does one hour; I do the next. Each time I enter a patient room, they ask for something, so each room entrance generally requires two visits to the room. Blood sugars generally require 2 to 3 room entrances. 30 seconds x 20 hand washings (washing in, washing out) = 600 seconds. 600 x 4 patients = 2400 seconds, or 40 minutes. I think it is realistic to say that I spend 1 hour of my 8 hours on duty washing my hands. They have brown spots on them from 10 years of this.

 So I now have 7 hours left. A good nurse can assess a patient head to toe, thoroughly, in 15 minutes. For 4 patients, that takes an hour. Oh, somebody wants to use the bedside commode, and it takes 30 minutes to transfer them to it because they just had surgery. Make your beginning of shift assessments 1 1/2 hours. But wait. Another patient is irate because they haven’t been told the results of their tests. It takes 30 minutes to call the doctor, and calm the irate patient. That makes your beginning of shift assessments 2 hours.

 You have 5 hours left. It takes 10 minutes per patient to get the right medications scanned, verify they are the right patient, and give them their pills. Add to that, that all the medications are not up from the pharmacy, requiring computer entry or a phone call; someone wanting water while you are in their room; someone needing put on the bedpan (requiring 2 more handwashings and a gloving), and you have taken up another full hour or more, just for a med pass.

You have 4 hours left. There are at least two med passes per shift, so make that 3 hours left.

A patient needs a dressing change. A doctor wants an update. There are checklists to fill out before surgeries; papers to put on charts before a patient goes to x-ray so other staff in the hospital know what to do if they stop breathing; patients needing transferring to or from a stretcher (2 more handwashings each). All of this takes 2 of the 3 hours you have left.

Of the one hour left now, 1/2 of that is your lunch. But someone wants to tell you their health history, or a story or a joke, and they take up the entire hour.

Add to all of this the fact that you work on a cardiac floor, where people are on cardiac drips that require vital signs every 15 minutes; but also happen to be on Lasix, and take off their blood pressure cuff each time they use the bathroom, which is more often than hourly. (Remember, 2 handwashings and a gloving for each of these you help with). Add to this that you are on the code team today, and an hour-long code was called in another wing of the hospital. Add to this that one of your patients puked up blood and had to be transferred to the intensive care unit which required an hour of phone calls, paperwork, and keeping the patient alive until they got there. (I won’t go into detail about what all keeping someone alive who is slipping entails, but I will say that 1 hour is a conservative estimate). Add to this a patient in isolation that requires not just handwashing, but gloving and gowning upon each entrance. Nowadays that is anyone with a HISTORY of MRSA, C-Diff or VRE, until they have 2 negative cultures. Add discharges, admissions which involve reviewing every medication a patient is on and getting it right. Add patient education.

Someone wrote in another blog (not my blog) in the comments section a question to me, asking if I was aware that hands were supposed to be washed both upon entering and exiting a patient room. This comment was in response to the recent publicity on MRSA infections in hospitals. When she stops breathing, if she is my patient, if I remember, I will wash my hands before touching her. It may compromise her ability to live however.

Yes, I am being sarcastic, and yes I am angry. I’m happy to fluff someone’s pillow, but don’t blame this entity of our society – this entity of what has transpired in healthcare on me. And don’t patronize me. I don’t have to be a nurse, and I just might quit being one. It won’t save her from MRSA. Blaming hospitals and drug companies won’t save her from MRSA either. Her immune system, and a smart doctor might. That is, if there are any doctors left.

 I have to chart all of the above. Remember, if it wasn’t charted, it wasn’t done, even if you did it. Tomorrow you have 4 entirely different patients. 5 months down the road, you run into a familiar face in the hall; the person talks with you as if you are an old friend, and for the life of you, you can’t remember them. They remind you…you saved their life. You still don’t remember them. You really, really wish you did.

What does it have to do with washing your hands? Nothing. Nothing at all. Do I have MRSA? I don’t know. I like to think that I colonize myself with enough non MRSA bacteria, and stay away from antibiotics enough to provide any that might hang out on or in me, with some healthy competition. Covering myself with my barn dirt is a great way to do this.

Spider Bite is Better

10 days of Amoxicillin did wonders. The baby’s thigh is soft, and there is a brown mark where the red once was. She still has loose stools, but they have more consistancy. Her bottom is no longer sore. Given that many of these wounds end up having MRSA (methicillin resistant staph aureus), we have much to be thankful for.

 Her follow-up appointment with the pediatrician is today. Bruce will have to take her alone because I’m working.

Transplanted Kidney Infection Discharge Fiasco

My father was sent home from the hospital Wednesday. I had called the social worker after the incidents with the dextrose in sodium bicarb and the diet change, telling her I thought my father would be safer at home. Home care can run antibiotics. I am beside myself with the mismanagement of my father’s diabetes in the healthcare setting while my mother manages his insulin pump.

 I’m sure the hospital staff is not happy with me. But he was discharged the next day. Meanwhile, a dietician had counseled my mother about the fact that there was no scientific proof that low glycemic foods were any different for blood sugar than high glycemic foods. She actually even printed out a page from the American Dietetic Association’s website and gave it to my mother. My mother confused the Dietetic Association with the Diabetic Association when telling me about it, and I was very confused. On the day of discharge, the diabetes educator came to talk with my mother, and explained the difference. I told her that after 35 years of my father managing his own diabetes, that the dietician was NOT HELPFUL. Giving my mother this print-out felt like an “in your face,” sort of reply to my mother’s persistant requests for low glycemic foods for my father. I knew the diabetes educator agreed, but she couldn’t tell us so.

Mother is writing a letter to the hospital, and is including the incident in her journal of what is happening with my father’s care. People will not change their attitudes without some help.

 Before leaving, I asked for a catheter strap. The aids didn’t know what it was, and thought I was asking for a leg bag. The nurse caring for him was pulled from the long term care unit, and she was the only one on the floor who knew what I was asking for. She said they didn’t have any on the unit, and she taped the catheter to my father’s leg so it wouldn’t get pulled out during transfers to the wheelchair, van seat and wheelchair.

Transferring my father into the van for discharge was a fiasco. If I hadn’t been there, he would have fallen. It was pouring down rain, and the hospital’s handicap ramp was too close to the edge of the drive-under area. It was wet. The nurse’s aids parked the wheelchair on the sidewalk with the intent of walking him down the ramp. I told them to push the chair up to the van door, and I insisted on orchestrating the tranfer. The ground was wet. The aids left his weak side unassisted, so I walked up and supported him. Most of his weight was on me, of course, and I am on light duty for hurting my back at the hospital I work at. I didn’t tell them so. We got him into the van without incident, thank God. I instructed my mother to wait until I got to the retirement home to get him out, and I sent my 17 y/o son with her to help in the van if needed.

When I got to the retirement home, after stopping for some things Mother had asked me to pick up, my father was already in the wheelchair, on the way into the house. My mother and my son were grinning proudly. My mother is so insistant on proving that she can handle this. And my father does so much better with her alone than with 3 nurses helping him. She has been doing this with him for a long time. I can see why doctors might question her ability to care for him, but doctors see so little, even of what goes on in the hospital. And they are far too dependent on what is reported to them.

I made my son help change my father the first time he soiled himself. My son had a hard time. But this is real life. At one time, I had said that I would not change my father when this happened, but the reality is, I’d rather do it than let others do it. I’ve been working in health care long enough to know that there is no way nurses and aids can know all the little idiosyncracies of every individual; that many of them overlook thorough peri-care; and that having family there means a lot to a person. I was suprised at my son’s determination to meet up to the situation.

My mother and father were both so happy to be home. It has been 3 days, and they are getting along great. Two days ago I picked up some diapers at Walmart and took them over. The home care nurse was there. When I walked in, Mother says, “Look what she brought!” On my father’s leg was a catheter leg strap.

Oh what things make a person’s day.

Spider Bite

The baby has a spider bite. It started off looking like a big mosquito bite. Bruce showed it to me a few days ago. Yesterday when I got home from work, it had grown, was hard and bright red, and had a pustule on it. It is on her right upper thigh.

There have been a rash of “spider bites” in the hospitals the past few years. They don’t really know what causes them. It is starts as something like cellulitis and turns into a carbuncle which has to be incised and drained. I have watched such procedures and cared for people in the aftermath. The doctor very often takes out part of the musculature or surrounding tissues depending on how extensive it is.

So with the baby, I didn’t want to wait until Monday. Yesterday was Friday. I fully expected her to be admitted and put on IV antibiotics. I called the pediatrician’s on call line, and was told to go to Wheeling Hospital’s ER. There we were put in the “Fast Track,” by triage. Had I known what that was, I would have known first off that we would thus most likely be discharged. She was sent home on Amoxicillin.

She has no fever, but she has had loose or watery stools since yesterday sometime, and her bottom is getting very sore. This was before the antibiotics, so whatever it is, it is obviously affecting her somewhat systemically.

I was pleased with the care. It was another situation where we were seperated by curtains, and heard every bit of what was going on “next door.” The patient was quite amusing, and I’m sure was making the day of the medical staff much more enjoyable.

Another Blue Mole

The day my stitches came out, over a week ago, was a monumental day. I took the steri-strips off my nose a day or two before that, and there were 3 small stitches. I felt like a mended toy from “Rudolph the Rednosed Reindeer.”

The morning of the stitch removal, as I inspected the tip of my nose closely, I noticed a vague dark spot that appeared much the same way the original mole looked, in the beginning. I pointed it out to the plastic surgeon. I could see her disappointment. She said that maybe we both missed it because the others were so dark, and it didn’t have enough contrast. I think she’s right.

My nose is still very slightly tender, but it is SO NICE to have that darker spot gone. The baby has been enjoying poking it and laughing. I am suprised that at 13 months, when I told her it hurt, she left the dressings alone. Yesterday she began gently touching it, and when it was okay, and I smiled at her, she cut loose and poked it and poked it! It was funny.

A few days ago I was shopping at Walmart. I glanced at the new spot in the mirror, and in that particular light, I noticed an altered skin tone in a circular radius area surrounding the spot, with an offshoot circular area next to it with no mole. These areas are a few mm in diameter beyond the center. I can’t see them in natural light. I can sometimes see them in the rearview mirror while driving. They look almost like a bacterial ring in a petri dish.

The doc called yesterday. I am paranoid she’s read my blog, but I know that either my bill is late being paid, or she wants to get another appointment scheduled. I’ll call her Monday, because the rings worry me.