A Quaker Nurse and Her Ramblings
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.
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.
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.
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.
I have an answer! The number of the dextrose on a bag of IV fluid is how many grams are in 100 mL (cc) of fluid. So D5W has 5 grams in 100 mL. That means if an IV is running at 100 cc/hr, then every hour, you are getting 5 grams of carbohydrates.
Now I can help my mother account for the carbs. But she just told me that his IV fluid was discontinued.
However, when they made his diet soft with nectar thickened liquids yesterday, they somehow left out the “diabetic” part. Arghhh!
Yesterday I walked into my father’s hospital room to find the large volume IV solution had again been changed. First it was changed two days ago from 0.9% normal saline at 150/hr to 0.45% saline at 100/hr. I had been wondering when the balance would change from fluid loss and dehydration to congestive heart failure and fluid overload with that solution and that rate. Yesterday it was 5% Dextrose with sodium bicarbonate, running at 75/hr.
The reasoning for the change is that he gained 11 lbs two days ago, and 7 more yesterday, and may be going into congestive heart failure. And the sodium bicarb is for his kidneys. I asked the nurse, “Does it have to be in Dextrose, and if so, why? The whole reason he is here with a kidney infection is because of out of control blood sugars.” She tried explaining to me that the dextrose had to do with electrolyte balance in the kidney.
Every nurse I come across explains and explains with so much misinformation it kills me, until I tell them I’m a nurse. Then they stop talking, and I start.
I am past the end of my rope. If this doesn’t make me an activist, I don’t know what will.
Two notorious persistant acts have made their impression on me in healthcare this week. Now in my experience, 30 to 50 % of the hospital population is diabetic. One act is the use of dextrose as the base of antibiotic infusions. The other is the habitual use of high glycemic foods for meals.
I have yet to find a healthcare professional who can tell me the number of carbs in any given amount of dextrose solution.
You would think that a hospital or other health care facility would be on the cutting edge of what is healthy and good for the patient. However, cultural trends prevail.
This has got to be changed. Until it is, no hospital has any grounds saying they are managing any patient’s diabetes.
Most people are under the impression that when a person receives a new kidney, that the other two are taken out. Not so. My father has a palpable bulge in his right abdomen. That bulge is now 14 years old, thanks to Prograf. No this is not a commercial.
Whenever a person with a transplanted organ is hospitalized, the medical staff is to notify the transplant team. There are good reasons for this. Namely, one good reason is to merely make sure that the transplanted organ is considered. When my father had a stroke on June 1, 2007, the neurologist in Pittsburgh at Presby was not concerned about the 3rd kidney, and did not feel it was an issue. He actually refused to call the transplant team.
There was an issue however. A urinary catheter was inserted. Within the first week of hospitalization – the first week of June – my father developed a temperature one night that disappeared the next day and did not return. A labile temperature is one of the primary signs of a urinary tract infection, a.k.a. UTI. I mentioned it to the nurse, but nothing was done.
Later, my father was sent to the hospital from the acute rehab facility for an increased temperature and more leaning to the left. The temperature went away, and was forgotten. They focused on his possibly having another stroke, and on his blood sugars. Again, I said to one of his nurses, that he had infection, probably related to out-of-control blood sugars, and nothing was being done about it. And again, nothing was done about it. He was discharged.
This time, when he had a temperature, I told my mother to ask the home health nurse to come and collect a urine specimen. She did. By now, early July, there were greater than 100,000 bacteria in his urine. They did a CT scan of his kidney, and guess what? It was “infected,” and “stranded,” whatever that means. But a stranded kidney isn’t good. Maybe if the infection had been addressed when it was in the bladder, the kidney might never have been compramised.
The director of the retirement home my folks live at said that my father’s white blood cells were not elevated earlier, so he couldn’t have had an infection. I didn’t want to argue with him. Everyone means well. But my father is on Prograf.
Prograf is an anti-rejection drug that went on the market in the 1980’s. It suppresses the immune reaction towards the transplanted kidney, but also to infections. My father was taking it during the research on the drug, and we knew of it then as FK506. The research was showing so much success that it was stopped early to put the drug on the market.
Judging from the first spiked temperature (which by the way, with antirejection drugs is a late sign of infection), my father has had a UTI since early June – for a month. His transplanted kidney may be damaged. And some neurologist in Pittsburgh doesn’t realize that by not calling the transplant team, he has probably shortened my father’s life. My father’s life was and is most definitely in jeapordy. There is a reason for protocol.
A lawsuit would not compensate for my father’s life and health. Nor would it fix the system. What would? I am going to have to think about that one a little more.
There is the hat from Hilton Head. We all bought one impromptu right before kayaking on the sound. It has a cloth band around it and a tie at the neck. It is my favorite one.
There is the hat with beads woven into the base that I bought because it was pretty.
There is the denim hat I bought when I decided to get divorced in 1993. I still have that one.
I rarely wear hats. I’m not really a “hat” person. But I am only 42. I have 40 years to go, maybe. Once upon a time, I was a kid who loved to swim. How many times did my nose get burnt to a crisp, and peel? I lived for going to the lake, or the beach, or the pool. How many times did I drive the farmall tractor around the hayfield in cut-offs and throw bales in sleeveless shirts, scratching up my arms? How many times did people think my brown hair was really blonde during the summer? When sunscreen came out, I bought the tanning oil that made you tan darker, not the protective stuff. Tanning lotion had bad chemicals in it – and what were the chances of me getting cancer? That happened to old people!
Yesterday I was waiting for my stitches to be removed. The man who came out before I went in had a bandaid over the bridge of his nose. He was “elderly.” He looked in the mirror and said, “I want to see how handsome I look.” I replied, “At least it is on the bridge of your nose and not the tip.”
He squinted – presbyopia – to see my nose a little better, his neck pushing his head forward. I’ve gotten used to those looks. Then he smiled. That always happens. Then there was the suppressed laugh – the ever-so-slight chest heave that people get when they are trying hard to be polite. But it was okay because he had a bandaid on his nose, and I had 3 stitches in the tip of mine. I chuckled, and he let the suppressed snigger out.
After he walked out, I looked around the office. There were expensive furniture and mirrors; a nice hat rack; expensive magazines. Her plastic surgery business was lucrative south of Pittsburgh in the global warming era. Her office had a west coast air about it, somehow, but I couldn’t put my finger on why. Maybe it was the wholistic health atmosphere, and her caring attitude.
Sun hats denote a change in my way of life. Will I regret my foolhardy youth? It was fun. If I could go back, I would’ve worn sunscreen.
Yesterday the stitches were removed from the tip of my nose. Dr. Pare said no sun whatsoever to my face for at least 3 months. The morning before stitch removal, looking in the mirror I noticed another small, faint blue spot above where the old ones were. She looked closely at it. Yes, it has to come off too – in 6 weeks. Maybe we didn’t notice it because the others were so dark and there wasn’t enough contrast to see it. Or maybe it is new.
The biopsy report said abnormal blue nevus. She said that on a cancer scale, with no cancer being white and cancer being black, that my spots were dark gray.
I have pulled out my hats.
