Which way is the Wind Blowing?

Nothing smells worse than a dead 'possum, especially if said 'possum is between the insulation and the floor of your bathroom. When the wind blows from the South (ocean direction here), the smell is unbearable, and that is the direction the wind blows most of the time. I have laid on the ground and cut the insulation cover and pulled the insulation down, but my arms, not being 6 foot long, cannot reach the area where the suspected critter met his demise. In fact, not sure if I want to. The stench has improved, but not gone yet by far. Everything in my bathroom has been pulled out of the cabinets and under the sink, we even pulled up the false bottom under the sink, nada. To make this all worse (for me at least), is that my hubby has a very weak stomach. That means that "I", being a nurse with a "strong" stomach, gets to seek out the source of the decomposing corpse. THIS IS NOT FUN. I WANT TO GO SOMEWHERE FUN...NOW.

Moral of the story: When going out of town for the weekend, and you wish to rid your home of "mice", don't put poison under your house...there may be a bigger, smellier critter lurking around.

I wonder if I could rent a hotel for the holidays? I wonder now big of "sticky" traps I can buy. Is there a product called "Corpse be-gone" or "Decomposing body Oder eater" or "Freebreeze for Decay"? I would "kill" a 'possum to get my hands on something that would eliminate the smell.

What he brought home from Vietnam

Working in ICU, I seem to always be seeing and learning new things. Who would have thought I would ever take care of a patient with Tetanus (Lock-Jaw), a disease that has been pretty much eradicated in our country? Now I have cared for another patient with something I never thought I would see in my lifetime: Hansen's Disease (Leprosy). I did not even know what Hansen's Disease was, so I asked the nurse giving me report, "What the heck is that?". He had cared for the patient 12 hours without even asking that question. We googled it on our iPhones (management has taken away our internet use and we don't have any "books" on the units), and were amazed to find that Leprosy is now called Hansen's disease because so dude discovered the bactrium rods that prove the diagnosis.

Hansen's disease can be treated, but not really cured. It is simular to Tuberculosis and the medications are almost the same. Apparently there are thousands of cases here in the United States every year. The Armadillo is a carrier of the bacteria (another good reason to run from the scaly armored digging machine). Usually Leprosy is contracted in another country, a 3rd world country, where the sanitation is not good and the water is not clean. In this man's case he contracted the disease in Vietnam while serving in the military, judging from his age, it was probably his 3rd or 4th tour of duty. The article I downloaded stated that the incubation period could be up to 30 years.

This man had documented treatment at least 3 years ago. Apparently he was not following up with the VA or his family physician. He had gotten neuropathy to the point that he could no longer walk. He lived alone, his family all lived far away, and no body took care of him. No one, at all....apparently even knew what his diagnosis was or how sick he actually was....no one. With the stigma that this bibical disease has, I would venture to guess he didn't talk about it much.

Finally one of his children traveled to see him, and seeing the condition he was in decided to stay to take care of him, but his father refused to let him take him to the doctor (maybe a little dementia setting in here). The son, who had no medical training, tried to care for his father to the best of his abilities, but he was already so debilitated and covered in decubitus ulcers (bedsores) that the care he needed was beyond his skills. His father began having difficulty breathing and was brought to the hospital by ambulance.


Now he is recieving end of life care and will probably go home with hospice. I am puzzled that any ex-military, who should have been recieving military benifits and medical care, could have gotten to be in such poor condition...in this country with all the medical advances we have. I would think that there would be a Social Worker who would follow up when patient's with chronic conditions just stopped showing up for their appointments. I would think they would at least contact them by phone to be sure they were still alive. I know that patients are in part responsible for their own health, but sometimes, just one person going out of their way can make a big difference.

The physical manisfastations of this disease was horrible, the neglect of someone who served our country so nobely....criminal.

My Birthday Weekend

I worked this past Saturday. I was put on call, then called in by 8 a.m. for ICU. When I saw my patient's, I had a sinking feeling in my heart. One patient was post surgical, no problem. The other, I had cared for several times over the last few months, over the course of several hospitalizations. I knew I was in for a hard day. Patient's mom is also a nurse, and is very helpful with the patient, but when the nurses kid (twenty) is sick, soooo sick....somehow, the whole family because a patient by extention.

Unfortunately I could tell this was going to be a heart wrenching day, and within hours the family finally decided to honor the patient's wishes and made her a DNR. OMG, it was so hard. The families pain was so hard to bear, as they bravely helped their loved daughter thru her last hours.

After it was all over, the mom and sisters insisted on doing after-care and saying good-bye. I gave them their privacy. I don't think I have ever been so sad at work. The secretary said she had too leave our unit because I was making her cry! I was so glad to leave work that evening.

The next day was my birthday, and I was called off, so I was able to recoop. I have prayed for this sweet girl and her family every single day since. It really makes you realize how precious this life is and how short it can be.

Ends and Pieces

Today I was off and running around shopping for this and that. Seems like that is the way life has been lately...a little of this and a little of that.

Good news: My knees are much better now. I found out I have arthritis, though why it suddenly flared up to the point of hardly being able to walk is a mystery. I blame it on the on again, off again weather systems (hurricanes) since it started when tropical Storm Alex was tracking near hear. I now have pain med, vitamins and steroids and the pain is gone in the left knee. The right knee is still recovering from me dropping my 800 pound motorcycle on it on pavement. Good thing Dave was there to untrap me, since I couldn't get my leg out. Note to self: Stay off the damned front brake girl!

Good news: Looks like everything is shaping up for me to go to my 35th class reunion. Now how in the hell did I get so old? Seems like just yesterday I was trying to choose a dress to wear under my graduation gown (like anybody was gonna see it), and praying that the thunderstorm would pass so we would still be able to graduate in the football field (it did, and we did). I haven't seen my older brother in two years (fishing trip) and we graduated together. He is not going because of financial reasons (he could go with me, but we are riding motorcycles...and I don't think he would ride B*tch!). We are planning on stopping on the way back to visit him.

Good news: Work is going great in spite of the economy. Our hospital is "up for sale" so to speak, but our Med-Cath owners are still holding their own stock-wise. Our hospital did a record breaking 27 heart surgeries last month (we are the "little" heart hospital), and we have not had many cancellation or call off days, and it was still "summertime". October 1, starts our actual "busy" season, as the winter Texan's start returning to the valley. I'm already getting calls to work on my days off, and I know it will only increase. Our new travel nurses are starting to arrive, and work, and it nice getting to know some new people.

Other stuff: My son has gone back to work, almost for 3 months now, and is doing good. My other son's hand is better and he is back to work. Everybody is healthy, and we are all getting by. Dave is as usual, wonderful.

And that does it for all the little ends and pieces going on in my life. Isn't it theraputic to blog? I get to start counting my blessings!

Floating

Well I was having a fine...semi-crappy week, when they decided to float me to 3rd. Well, I don't mind floating, but I have only floated to that floor one time in 4 years, and I'm pretty sure it was almost 4 years ago. I got report. No body bothered to tell me where the supplies were kept, or any of the forms. The regular nurse on the other side didn't even bother to tell me her name. Some of her patient's records were on my side, because she apparently had the middle group, although I'm not sure since no one bothered to explain how the patient's were split on that floor. Everybody thought that were my patient too...and I had to field family requests and doc's and phone calls for you, the unknown nurse for the unknown patient's!
I worked my ass off. Transitioning from being a cardiac nurse to doing pretty much all GI stuff (three post exploratory lap's, with two ruptured appendix with open laps, and a few other goobly gook's thrown in to confuse me) was no easy task. I literally had to think myself through everything I was doing. (What no Open Hearts...no chest tubes....no harvest sites???)

About two p.m., when I was about to drop from lack of nurishment (no breakfast, no lunch, although my assigned aide had managed to disappear for breakfast, mid-morning break, lunch, mid-afternoon break) while I earnestly medicated, did pericare, took people to the bathroom, turning and doing all the things that normally two people or at least THE ASSIGNED AIDE does, when finally the Nurse Manager walked by to ask how I was doing.....HUNGRY and about to pass out was my answer. Oh, we have two nurses assigned to float around and help, haven't they helped you??? Well one of them had informed me she was the "admission nurse" and did admission's only. The other had informed me that if I had a difficult IV, that she would try if I tried several times first. So there is all this help available, and I am drowning, because no one will even show me where to find stuff. I was literally alone at the station 90% of the day answering the phone's, call bells and taking care of my assigned patient's. I hope they never float me to that floor again!

The topping on the cake was when on of the GI doc's was rounding and asked me a question about his patient...you got it Exp. Lap, then open lap with appendectomy...and I didn't know the answer off the top of my head without looking at my paper's or the chart...he remarked " You certainly don't know you patient very well, do you?" He points out the info he needed in the chart (a lab report that had been placed by a med records tech while I was in a room)....like my remark was..."Gee, there it is...right were it belongs". Moron! My husband saw this same doc for a Colonoscopy last year...guaranteed I will never see him...he will not get one more red dime of my money....asshole. Read this people....I AM A CARDIAC NURSE...I KNOW ABOUT GI PROBLEMS, BUT I AM NOT A SURGICAL NURSE!!!!!!!!! I AM HELPING YOU PEOPLE OUT, BECAUSE YOU ARE "SHORT" STAFFED, WITH YOUR TWO FLOATING NURSES TO "HELP" OUT WHO NEVER "HELP" OUT...MAYBE IF THE PEOPLE ON THAT FLOOR DID THEIR JOBS PEOPLE WOULD WANT TO WORK WITH YOU.

OK, now I feel better.

People that Quietly touch your life.....

Sometimes a patient will touch you, in unexpected ways. Just seconds, that become a memory, that comes to you from time to time. Last week, it was a physician, who was my patient. Going for surgery, outcome expected to be very good.

He was humble, not arrogant at all, not expecting extra perks or favors from being a V.I.P., just a very nice guy. I gave him all the info about his surgery, even though I suspect he knew more than I, because I thought having the more basic information would help to calm his family down some. I remember when I was a patient having a procedure, that although I was very familiar with what was going to be done, it is still very scary knowing you are the patient, putting yourself in other (hopefully) capable hands. The lack of control over the situation, is in itself anxiety inspiring.

While I was off, this patient went to surgery. I was expecting to already have him back on the floor as a patient, as we get post-op hearts out as early as on the first post-op day. I found out yesterday, which would have been like the 4th post op day that he had to go back for another procedure, and that his outlook was very bleak. I was shocked! I would have absolutely thought this mans outcome would be great, he looked healthy, he had a positive attitude, lots of family support, and a good surgeon.

I am in prayer for him and his family. I was very touched by this humble unassuming man, who you would never suspect was a physician.

Been out playing...not blogging :)

I looked back at my blogs today, and gee it's been over a month since I wrote anything. So much has happened in that time frame. I left night shift and now I work days...not having any trouble getting up in the morning, just still working on time management skills since the day shift stuff is so different from the nights. Days is all about hussle and bussel and hurry up: Report, doctor rounds, med run, orders to take off, breakfast (for the patient's), pt's to and from tests, all that pretty much at the same time...then 11:00: doctors AGAIN, VISITORS, lunch (for the patient's), med run, whew...breath...usually by this time it is around 2 p.m. or 3 p.m., hummm I haven't eatten, drank, or urinated in 7 hours or more. I usually take a deep breath, and look for a sucker to cover the desk so I can do the three things I must do..eat, drink, and make water :). My 30 minute break is usually 15 minutes of food shoveled into my mouth, while usually having to go back out to answer family member or doctor questions. Sunday I actually got my salad dressing on my salad and had my first bite in my mouth...and had to leave for 45 minutes to round with a doctor...then a patient wanted pain meds, then somebody else stopped me...I thought I would pass out before I got back to the food. I have taken to keeping a coke in the fridge because my sugar drops so low I start getting black spots in front of my eyes! I had forgotten that about when I worked dayshift before.

The worst thing about days is that I am forced to carry a specta-link at all times...heaven forbid you actually are unable to talk, it always rings when you are in a patient's room, gowned, gloved and doing something that takes total concentration. If you fail to answer the phone...somebody will start banging on the door...hey answer your phone...off comes the gloves, off the gown, excuse me, I will be right back....WHAT HAPPENED TO: Allow me to finish my task with THIS patient, TAKE care of everything THIS patient needs at this moment before you pull me out to THAT patient's room. UNLESS it is an emergency each patient is EQUALLY in need of attention. I will get to EVERY patient's room as soon as I can, but I can NEVER be in SIX ROOMS at the EXACT same moment...can't somebody else: get them ice, turn them over, place their oxygen tubing back on, or take them to the bathroom? Why can't the AIDE or the SECRETARY ask them what they need first. "What do they need?" "Duh...I don't know, I'm not the Nurse, they said they want their Nurse." Insert VERY LOUD SCREAM HERE!

Deep breath...so in order to relieve all the stress of work I have taken up the extreme sport of Motorcycle riding...

Death is not always...so neat...

As a nurse, I get very used to seeing death. Death is mostly expected...somebody has been sick a long time, or has a very bad diagnosis. We are not surprised at the outcome, the body wears out, life has taken it's toll, cigarettes....drinking...bad decisions, sometimes cancer and things just totally out of our control. Death is always sad, even when it is the expected outcome. We do post-mortem care...remove IV's, foley's, lines, tubes, and clean and wash the remains, it a very quiet and respectful, meaningful task. It is an honor to perform this necessary task, so the families last view of their loved one at the hospital is in as natural a state as we can achieve.

When death is unexpected...things are not quiet so neat. In the hospital there will be the wreck of the room...tubes, lines, gauze, syringes...you name it, strewn all about the room. The Resuscitation team will work with a frenzy to try to bring the patient back if their code.

This weekend, I got a taste of a different kind of death, the kind that the First Responders and EMT's see on a daily basis. I gotta say, I am glad there are people cut out for that kind of work, because I can tell you I'm NOT one of them.

We were on our way to the beach. The weather was fairly nice, 83 degree's, but it had started misting. We had our cruise control set...after all...we had a vehicle full with my niece, her fiance, her two kids and my grand-daughter...in addition to me and Dave. A jacked-up Ford club-cab passed us just flying. We caught up to him when he got behind a slower vehicle...which he promptly passed. Dave and I agreed that the dude was an accident waiting to happen, as he was passing without adequate space. We remarked to each other that if he didn't wreck, he was gonna cause somebody else to wreck. Unfortunately we were right. He went to pass another vehicle...had to jerk back into his lane, but his truck started rolling. It rolled twice across the opposite lane of traffic, and then hit the ditch and the palm trees. The driver wasn't wearing his seat belt and was ejected out of the driver-side window. He apparently was dead before leaving the truck, since there wasn't much blood....I should know, since I was the first on the scene and was the one who covered him with a bright beach towel. His cousins were with him, and Thank God, wearing seat-belts. The male had already bailed out the broken window, in shock, and told me "don't look at him, he's dead!" I told him I was a nurse and I had to look at him to see if there was anything I could do. It only took one look to see there was nothing I could do for him. He was lying on his stomach, but his head was facing me (in retrospect I realized his neck was totally broken). CPR was not an option as he no longer had a mouth, or even one whole side of his head. The man probably weighed close to 200 lb, but it looked like every bone was broken...like a child's toy...tossed into the ditch. Later, when I was assisting with the woman inside the truck, I found his left mandible lying in front of the truck on the ground...totally bloodless, fleshless, and very clean looking., and probably one of the most horrible things I could have found.

The female passenger was in shock, I had her unlock her door so I could check her out, but instead of staying in the vehicle, she of course bailed out as soon as the door was open (not that I blame her!). I gave her a beach towel to use as a blanket and sat her on the ground. EMS still hadn't arrived and neither had the police...we were out in the middle of no-where's-ville. I asked if they had been drinking...and she said no...and I believed her ...there was no odor of alcohol, or other indication that alcohol was involved. I had given the male passenger a beach towel for a blanket also...but had abandoned him to treat the female because his adrenaline level was so high...he was aggressive (SHOCK!) and I didn't want to agitate him. My sweet husband was busy fetching me towels and trying to get hold of 911.

I know it felt like forever, but EMS and the Constables were there in minutes, then the Laguna Vista Police arrived, although in fact were were a couple of miles outside of the township. A female responder, who was pretty hefty (read: muscled) just picked that lady up like she was a feather and carried her out of the brush. I was very impressed. I was also very glad to relinquish the response effort to somebody better equipped. I had no gloves, no stethoscope, no anything...just beach=towels and my brain.

DPS arrived and took our statements. The children were upset and crying...There had never been quite so close to death before. I promised them new beach towels from Wal-mart on our way to the beach, which pacified them. I, on the other hand, am still thinking about the wreck and what I could have done better or different to help the two survivors. The worse is the dead driver...who will never had that second chance to slow down and wait to pass...to have that chance to get to the beach. In a blink of an eye...his life was over. He was young, healthy and had everything to live for...and that is the saddest part of all.

Coca Cola

Had a patient in ICU, total liver failure, very sad case. Young guy not even 40 yet, probably won't live to see his next birthday, emacipated arms and legs, huge pregnant looking ascites belly. Lot's of co-existing problems, since the liver does so many things besides filter blood. The liver has a lot to do with blood coagulation and so on.

Well the little guy had a Nasal Gastric Tube and was getting feeding via the tube. I had done all the proper things like flushing the tube, checking residule, hanging new tubing and new feeding. I had noticed that the flush was a little sluggish, but nothing really concerning, until I needed to give some medication just before end of shift. I go to check residule and the tubing looks like clabbered milk. Ummmm, cannot aspirate with large barrel syringe, cannot push H20. Ok by now I'm starting to sweat. I have to unplug this sucker. Removing it and placing another is a no go because of esphogeal varcies and the high high high risk of the duke bleeding to death. The best solution is usually to place some soda in the tubing and wait then work it until it clears, the only problem there is the hospital no longer provides cola's for the patient's (budget ya know). Well, it just so happened I had a soda in my fridge stash (my dear hubby had sent it for my lunch two weeks ago, I don't drink soda so I had just saved it) so I put some down and worked and worked and worked. I was finally able to aspirate part of the feeding (which is like baby formula...only like I said clabbered). Dude asks me what I'm doing, he has been without anything to eat or drink by mouth for 20 days, I tell him I'm putting Coke Classic in his tubing to clear it. He gets a big grin and says "Coke...I'm getting Coke...wow!" It was so funny.

So this morning before I leave I go in and flush the tubing, he looks at me, raises his eyebrows hopefully and queries "Coke???". It was just so funny!

Dancing Time in Texas

Tonight, we were gonna go to the Los Fresnos rodeo, however, after two days of rain, the mud deterred me. I don't do mud. Instead I opted for us to go to Wink's Grill and Bar w/attached arena. It is the coolest place. We took Angel to eat and stay (just until 9:30) for a little music. Inside it is very rustic. Rough cut cedar on the walls decorated with deer heads (yup a mans paradise I'm telling ya). It also has a full sized windmill turning by the dance floor. One edge of the dance floor has a mechanical bull with a blow up safety bumper. This place is HUGE! The stage has a full sized wagon on it, and tonight the drummer set his drums up on it. (We did leave before the live music because I was afraid it would get too rowdy for a 10 year old, even though lots of people were coming in with children...just doesn't seem right to have them out late with all the drinking stuff going on). The bathrooms are sooooo cool. The sinks are metal #3 washtubs and the sinks have actual old-time pumps that pump into a wooden bucket, then the water runs out the bottom where you wash your hands. The handles on the sinks are deer antlers. The rest of the bathroom is early sheet-metal decor, but thank-god for state-of-the-art tolits.

I spent a good bit of time teaching Angel to jitter-bug and two step. Then there was a party for a Quincentina (not sure if I spelled that right), which is a Hispanic traditional coming out party when a girl turns 15. The teenagers requested some line dancing and Angel was soooo in her element. Who knew that they teach line-dancing in elementary school as part of their PE? She did very well, and was adequately impressed that her "granny" picked right up and did all the moves right with the teens. Little did she know that I was a hard-core three times a week line dancer in my hay-day!

We had a very good time, then came home and watched an old Jim Carey movie "Liar Liar" and went to bed. Tomorrow we will possibly attempt going to the Cameron County Live-stock show and the rodeo. There is also a carnival and craft show (woo-hoo) so I'm looking forward to it (ok, I hate heights...but I can sacrifice myself to ride the scrambler with the grand-girl child I'm sure!

Did my brain Turn to Mush???

I really had an awesomely crazy night the other night. I arrived at shift and there was no one there to give me report. I was confused. My pod was empty, no patients, no nurse, nada....was there some kinda mistake. Did the House Supervisor have a brain fart, what the hell? Within seconds I realized I was living my worst nightmare..without Vaseline. I was alone because I was "opening" the pod for all the patients that had been holding all day in ER.

I got a direct admit that was being wheeled out of the elevator as I was scratching my head in confusion (over the "empty" pod). One minute later they are wheeling my transfer from ICU, as the phone was ringing for me to take report from Day Patient on "my" patient that has been waiting for a bed for over an hour. Oh, then the aide calmly informs me I have two new admits waiting in ER.

Pause, take a breath here, hummm, usually in ICU, or even PCU, you will only get one and possibly two admits in a night, and one of those is usually a transfer. Transfers are the easiest because they already have their database done and most of the paperwork has been completed. Next easiest is the ER admits, even though they come with a billion orders at least they have a IV access and a rudimentary history and some meds have usually been given, and the patient is relatively stable. Direct admits are the hardest. Not only do you have all the paperwork to do, but you also have to try to twist Pharmacy's arm to get their first dose medications issued, and you have to start an IV.

Well, I get the gal from the elevator. Reception did not bother to put a mask on her, or to inform us that she had a nasty cough, which of course she did not cover. What is it with people? Do they think they sound sicker if they don't cover their cough? I certainly hope she had a benign case of bronchitis or something, because if it was H1N1 or TB, everybody in the lobby, on the elevator or in the hallway were exposed. I immediately introduced myself, fetched myself a mask and put her on isolation.Then I popped into the next room to meet and greet my ICU transfer. Then I popped into the next room to get it ready for the Day Patient.

Two hours later I was transferring my ICU transfer to the Medical Floor and getting that room cleaned. I discharged my Day patient home. I had started an IV on my Direct Admit and I was talking to Pharmacy for the umpteenth time for...you got it...my first dose medications. I then proceeded to get THREE ADMITS FROM ER. Count them...THREE. I was so tired at the end of shift, I was trying to catch up my charting.

This was my charting. Patient received from ER via streacher (scratched that out), via strecher (scratched that out), strechar (scratched that out)....scratched my head...Patient received from ER via gurney.....

Then I went home and slept.

Wide Awake in Texas

I worked Monday and Tuesday nights, and was off yesterday. I came home and caught a few zzz's then had to get up and go the eye doc to get a recheck on the bifocal contacts. If anybody has actually learned how to wear the mono-focal's ....shish, I sure hope they start working for me. My right eye is for far away vision and my left for reading...the only part he didn't tell me is that my already poor depth perception would become practically non-existent. I am working on driving without running into anybody, and walking like one leg is not shorter than the other. Updates to follow.

The Christmas Dress

What we did around Christmas.

Dave unloaded the propane, so we could cook Christmas dinner. It had rained torrents of rain..for days. Note the stylish "hog" boots he is wearing.

Then we cooked out and ate fahita's. It was all good.