She is back in the hospital. For the zillionth time. When she leaves here she will go to the sister facility two blocks North. When she leaves there she will go to the smaller facility in the next town, then to the bigger city. In about 6 weeks when she has exhausted all of those she will be back.
She has no insurance. She has no job. Her hubby goes with her from hospital to hospital, he is also unemployed. They are not elgible for government programs (Think "Rio Grande Valley").
She can't afford her drugs. She is non-compliant with her medical management. The MD's know her well. Her drugs of choice: Lasix, Anti-hypertensives, and Insulin.
I doubt they have a home, maybe visit family or friends for the one or two days a month she is not admitted in acute CHF. December bought her a CABG for Christmas...Thanks to the Taxpayer's....even though the doc's know she is a poor risk, non-compliant, what are they to do?? The sad part....she is 41 and knows she is dying.
Drug Seeker...yes, non-compliant...yes, but as a patient...she never asks for anything except a little water. Never complains of pain, never asks for pain medications and is grateful for any little tiny thing that is done for her. I have patient's with the greatest of Insurance, who have a multiple of pills and plenty of help at home. They have food, clothes, heat and a roof over their heads. They demand bowing and scaping, and yes I'll get that right away...after all....isn't this Hotel Hospital???? Yet, this one simple woman touchs my heart.
Wednesday, January 31, 2007
Sunday, January 28, 2007
Day's Off are....Great
Much as I love being a nurse, and plying my skills on the innocent...I love being off so I can recoop from a hard, long and tediously long shift. Working nights, the 1st day, of course, is sleep time, so with the three day weekend, I am in heaven. My last work night was hell on earth, one transfer and TWO admissions. Doesn't sound like much ... but for night shift that is quite a load...especially since there is no pharmacist at night and you are hard put to find medications in the Pyxis, especially since a lot of the drugs need the House Supervisor to overide. Luckily, the House Supv. is on our floor, and her office quite handily was on my pod (yea!!!).
I had one new patient, that I kid you not, had 25 home medications including his daily OTC Vitamins. The kicker??? The doc in ER and the Cardiologist did not choose to continue his medications...until he was seen again the next morning.....after his second EKG....but they didn't bother to tell the patient, who was just convienced that the *evil nurse* was just with-holding his medication...or just too freaking lazy to go and get them. He threatened me "I am going to get chest pain if you don't get my pills NOW!" Well I applied the handi-dandy Nitroglycerin ointment to his chest (it was the only thing ordered), put O2 back on him, and instructed him to breath deeply and slowly (to calm him down), then I carefully explained to him why he could not have his zillion pills at this time. I stressed that the doc was waiting on the 2nd EKG and his ECHO readings...and that also some of the medications would have been held anyway...seeing as he had arrived on the unit "stable" from the ER...with a blood-pressure of 52/30 following the Lasix he had been given ...oh, but they held the NTG paste because his BP was low..... hummmmmmmmm....that was a fancy piece of critical thinking. They did a BNP....thinking possible CHF, but get this....he had a D-Dimer of over 3000 and they didn't do PE protocol or CT of the Chest (oh yes he was admitted with Shortness of breath).
My other patient, a lady, who takes only one med daily, came in short of breath ... Her D-Dimer was NORMAL, but they did PE protocol and a CT of the Chest on her....the difference...beats me. He arrived on Day shift when all the diagnostic tests were quite easily obtained and she arrived at night...! At night we DON'T have a PHYSICIAN, but a PA, who works his ass off. Remind me to only go to the ER at night...when the smart one is working!!!
Anyway, I have been recooping....drank a boatful of good Margarita's, went dancing with my man and some friends...and just chilled to the max. Now I need to recoop from the recoop. Ha.Ha.
I had one new patient, that I kid you not, had 25 home medications including his daily OTC Vitamins. The kicker??? The doc in ER and the Cardiologist did not choose to continue his medications...until he was seen again the next morning.....after his second EKG....but they didn't bother to tell the patient, who was just convienced that the *evil nurse* was just with-holding his medication...or just too freaking lazy to go and get them. He threatened me "I am going to get chest pain if you don't get my pills NOW!" Well I applied the handi-dandy Nitroglycerin ointment to his chest (it was the only thing ordered), put O2 back on him, and instructed him to breath deeply and slowly (to calm him down), then I carefully explained to him why he could not have his zillion pills at this time. I stressed that the doc was waiting on the 2nd EKG and his ECHO readings...and that also some of the medications would have been held anyway...seeing as he had arrived on the unit "stable" from the ER...with a blood-pressure of 52/30 following the Lasix he had been given ...oh, but they held the NTG paste because his BP was low..... hummmmmmmmm....that was a fancy piece of critical thinking. They did a BNP....thinking possible CHF, but get this....he had a D-Dimer of over 3000 and they didn't do PE protocol or CT of the Chest (oh yes he was admitted with Shortness of breath).
My other patient, a lady, who takes only one med daily, came in short of breath ... Her D-Dimer was NORMAL, but they did PE protocol and a CT of the Chest on her....the difference...beats me. He arrived on Day shift when all the diagnostic tests were quite easily obtained and she arrived at night...! At night we DON'T have a PHYSICIAN, but a PA, who works his ass off. Remind me to only go to the ER at night...when the smart one is working!!!
Anyway, I have been recooping....drank a boatful of good Margarita's, went dancing with my man and some friends...and just chilled to the max. Now I need to recoop from the recoop. Ha.Ha.
Tuesday, January 23, 2007
Here comes the Judge!
She was emancipated, dirty, dehydrated and confused. Why am I here?? When is the helicopter coming to get me??? Call my husband W...., he doesn't know where I am. What are you doing to me. Why am I here....
*She* had been in the bed sick for two weeks. No one knew what was actually wrong with her. She quit eatting and drinking. She didn't take her pills...any of them...although EMS found a shit-load of them sprinkled on the bed covers. Her daughter had been trying to call her for days, without a response. Her Husband *W* , also has Aizheimer's, but not as "bad" as her case. They are Winter Texan's ... who winter by the sea-shore on the Gulf when the weather gets bad. Unfortunately...Texas, like the rest of the nation, is experiencing unseasonably cold weather. As Winter Texan's these people were unprepared for the cold. They hold up in their rolling homes on wheels, bundled up in the covers...developing DVT'S and waiting for the warm to return.
Her monitor is going off. I dash to the room, Sinus Tach 130....She is sitting calmly in the bed with an electrode dangling from her mouth, nursing it like a lollipop....."What is this?" She asks, shaking the offending tasteless electrode at me. She pop's it quickly into her mouth. She has managed to strip off her gown and almost get on her gray sweat-shirt. She looks at me..This sad woman, with perfectly manicure nails...painted peach...with dirt under them. The sad part...Severe Aizheimer's has robbed her memory of almost everything...she knows she has a husband, who *knows* her medical history, and a daughter...who doesn't live here. She doesn't remember that she was a county Judge in West Texas. She doesn't remember where she is or why she is...just that the helicopter is coming to get her. How sad. Aizheimer's has to be the worst.
*She* had been in the bed sick for two weeks. No one knew what was actually wrong with her. She quit eatting and drinking. She didn't take her pills...any of them...although EMS found a shit-load of them sprinkled on the bed covers. Her daughter had been trying to call her for days, without a response. Her Husband *W* , also has Aizheimer's, but not as "bad" as her case. They are Winter Texan's ... who winter by the sea-shore on the Gulf when the weather gets bad. Unfortunately...Texas, like the rest of the nation, is experiencing unseasonably cold weather. As Winter Texan's these people were unprepared for the cold. They hold up in their rolling homes on wheels, bundled up in the covers...developing DVT'S and waiting for the warm to return.
Her monitor is going off. I dash to the room, Sinus Tach 130....She is sitting calmly in the bed with an electrode dangling from her mouth, nursing it like a lollipop....."What is this?" She asks, shaking the offending tasteless electrode at me. She pop's it quickly into her mouth. She has managed to strip off her gown and almost get on her gray sweat-shirt. She looks at me..This sad woman, with perfectly manicure nails...painted peach...with dirt under them. The sad part...Severe Aizheimer's has robbed her memory of almost everything...she knows she has a husband, who *knows* her medical history, and a daughter...who doesn't live here. She doesn't remember that she was a county Judge in West Texas. She doesn't remember where she is or why she is...just that the helicopter is coming to get her. How sad. Aizheimer's has to be the worst.
Monday, January 22, 2007
Wake Up People
To all the stupid people who think that Mom is gonna live forever...even if she has had both feet amputated....multiple times...a piece at a time...Mom, who has been on Dialysis for umpteen trillion years, Mom who is in ICU, comatose, on three or four cardiac drips....TODAY....TODAY...was NOT the day to decide that MOM needed to be changed to a FULL CODE, against her express desires. Then after your OH SO CHALLENGED mental decision...you left after visiting hours, to go home, to peacefully sleep. WHERE WERE YOU...when she coded...and we called you??? DO YOU THINK we call at 3 am in the morning simply to annoy you...to wake you from your beauty sleep??? STUPID PEOPLE who respond to the nurse...I'll be by in the morning....HUH???? PEOPLE...IF A ICU NURSE IS CALLING YOU AT 3 AM IN THE MORNING AND ASKING YOU TO PLEASE RETURN TO THE HOSPITAL AS SOON AS POSSIBLE.....THAT MEANS NOW........MOM IS NOT RISING UP AND WALKING....SHE IS GROWING WINGS AND THE CHOIR IS SINGING!!!!!
We coded her 4 times...bless her heart, when I left this morning she was still breathing, ventilator assisted, the SON finally showed up around the 4th code, but was adament that everything be done...HIS mother is a fighter....poor woman.......all the doctor's could do was just shake their heads......
In Texas....especially the Rio Grande Valley...the patient's live forever...really...at least that is what the general population expect's...if you are a full code...you are not suppose to die.................EVER!
We coded her 4 times...bless her heart, when I left this morning she was still breathing, ventilator assisted, the SON finally showed up around the 4th code, but was adament that everything be done...HIS mother is a fighter....poor woman.......all the doctor's could do was just shake their heads......
In Texas....especially the Rio Grande Valley...the patient's live forever...really...at least that is what the general population expect's...if you are a full code...you are not suppose to die.................EVER!
Monday, January 8, 2007
Help the Patient's are making me SICK!
Knew it would happen one day. Now I have whatever bug is going around...the sinus, sneezy, mucoid type of thing that makes ya not want to pick your head up off the bed!
My comment when I left work this morning: Discharge all these people, when I come back, I don't wanna have "sick" patient's...I want well patient's ...the kind that complaint that their *coffee pot* is empty again....smile....and ya better bring the coffee...or he will suddenly have those pesky *chest pains* with the accompaning interventions....EKG, NTG, CALL THE MD....do ya thing CAFFIENE could be causing any of the pesky symptoms..................nah....that would be too easy. :)
My comment when I left work this morning: Discharge all these people, when I come back, I don't wanna have "sick" patient's...I want well patient's ...the kind that complaint that their *coffee pot* is empty again....smile....and ya better bring the coffee...or he will suddenly have those pesky *chest pains* with the accompaning interventions....EKG, NTG, CALL THE MD....do ya thing CAFFIENE could be causing any of the pesky symptoms..................nah....that would be too easy. :)
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