Must…Get…Moving! Must…Have…Control!

Must stop talking like Captain Kirk!

I’ve worked with nurses like this.

Good ones.

You will get up to ambulate post-op and you will not give excuses.

She heard them all!

And lord help you if you didn’t have a BM prior to discharge.

She had ways of getting you to go!

John may have had nurses just as tough.

He never got a chance to find out.

He only saw them once every four hours.

Or whenever his blood sugar was due.

And then only because he was on a sliding insulin scale.

Pardon my ignorance, but back in the Jurassic age of nursing we did what were called “rounds” on our patients at least every two hours. Guess they stopped that archaic practice while I was sitting on my butt in ER.

Geeze, that sounded snarky.

But it’s true! They kept John through the weekend and I went up to watch “Survivor” with him that Sunday night.

I hate “Survivor”.

I was there for four hours and saw what I think was a nurse once. No, I’m sorry, twice. Once for the blood sugar check at bedtime and then the time she brought pain medication.

One hour after John requested it.

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The next day, Monday morning, after a sleepless night, I dropped my son off at the airport for his flight back for graduation at 0530 and headed for the hospital so that I would be there when John was seen by his physician.

Looking back, I realize I had developed that pressured, frenzied behavior and thinking pattern that is part anxiety and part coping mechanism, that when combined with pure exhaustion presents as a paradoxical adrenaline rush that only seems to come at times of severe stress. Numb and yet hyperactive in both brain and body.

I had things to do.

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Looking at the notes I kept on that last day in the hospital, I can see how pressured I felt, although as time passes it is harder to recall. So here, in a very stream-of-thought fashion is an example of how my brain was functioning.

…check out glucometer cost, find out if insurance will cover and keep Glucotabs on hand.

…get John a doctor prior to a referral, my doctor isn’t taking new patients, get name of endocrinologist from him

…go to store, healthy food, complex carbohydrates, realize when one person in family is diabetic we all are

…call opthalmologist for eye exam and real glasses so John can read insulin syringe, also to check for any diabetes related damage

…realize I’m not groggy but have had no sleep in two days.

…check feet. John’s, not mine

…tell MY doctor I want what JOHN is taking for his BP because it works better than my med.

…get the clothes to the dry cleaners because we are leaving in 72 hours for South Bend, Indiana for son’s graduation and I need two more dresses.

…screw the dresses.

…buy donuts for nurses on the way to hospital at 0600.

…get to room. Set up “office” in room with, computer (no wireless I can hook into, dang), notepad, coffee, cell phone, patient phone within reach….

…Been sort of a hands-off family member until now, just observing.

No more.

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…now I want ANSWERS. Dammit, Jim! No more of this molly-coddling or amorphous “we aren’t sure” crap.

…WHY is the bilirubin still HIGH? {Ed. note: gallbladder gangrene; John was sicker than we realized}

…WHYis he in the hospital for if he doesn’t see a nurse except for once every four hours?

…Why CAN’T he go home and let me take care of the insulin and that damn Jackson-Pratt drain that has become part of his anatomy. I’ve seen one or two in my time.

….must clean house. Must water every plant in two mile radius of house.

…must not let anything die

…must be in charge

… have to get moving, it’s all on me

…afraid to leave room until I have seen both the surgeon and the hospitalist (where the hell are they?)

…start new blog as most of what I want to write has nothing to do with ER nursing. {Ed. note: you’re reading it}.

….realize that life is what happens while you are writing blogs.

…realize how life would fall apart if John died. Bury that thought. Deep.

….where are the doctors, it’s exactly 1023. Who the hell doesn’t make rounds until noon?

…realize I’m being irrational.

…realize I haven’t eaten for 16 hours. Realize I’m not hungry. Realize I’m living on coffee and Diet Pepsi.

…realize I may lose weight.

…realize there could be a positive side to stress

… realize I am Type A personality hidden under Type B facade.

…realize that I need to take a breath.

…realize that our life as we knew it is gone, to be replaced by a healthier and hopefully longer one.

And if you had seen me through all this, you would have seen an extremely professional, very polite, absolute Rock of Gibraltar.

Externally.

Next: You can handle what you know. It’s the unknown that scared the hell out of you.

Eeeeeeeeee-nough!

Romance!

Adventure!

Excitement!

Spectacle!

Nah.

More like “Pissed Off!”

Okay…. I like this poster because my name is on it.

Never mind that “Kim” is a guy.

Errol Flynn, no less!

I really should see this movie, now that I think about it.

I’ve had a thing for Dean Stockwell ever since “Quantum Leap”. And don’t even get me started on Scott Bakula…I’d need a whole ‘nuther blog for him!

This poster pretty much sums up how I felt while John was deep in the propofol haze of OR.

Except I kept my shirt on.

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It started with a call from my daughter in Portland.

I began reiterating all the frustrations of the past 24 hours. The more I talked, the angrier I got. I began, well, ranting, loudly, my voice echoing in the empty hospital lobby.

And then I realized. My daughter was not the one who needed to hear this.

I wanted the nursing supervisor. And I wanted her NOW.

I walked over to the hospital operator, who no doubt was privvy to my emotional state, being about 20 feet away from “the ranting family member” and asked, with firmness (and a politeness I didn’t feel) for the nursing supervisor to be paged.

She came within ten minutes.

Aw geeze! Not only had I worked with her in that hospital’s ER 6 years before, she had been the one to sign me out the night I had chest pain and had come in to work extra the night John had been admitted. She moonlighted as supervisor on the weekends.

The world of EMS is very small.

She’s the type of nurse who has a tough-as-nails attitude and look, but would literally fight for her patients if she had to.

We talked for over half-an-hour.

I told her my frustrations. The interminable waits. How fourteen hours from ER door to med/surg room was inappropriate. Why waiting one hour for pain medication was unacceptable. Why a 51-year-old man with abdominal pain radiating to his back doesn’t get seen by a doctor for three hours. Or get any pain medication for four. How I could not see his lab work but received report from his roommate and all the other patients were able to hear it.

I told her a four-bed ward was not acceptable. How was anyone supposed to rest? How eleven people had crowded into that tiny space that day. The risk for iatrogenic infection. Good ol’ HIPPA.

A.J. the supervisor (not her real name) was quite frank with me, probably because I was an nurse (finally!).

The night John was admitted, the ER (that hellacious, busy, trauma-based ER where I worked for a whole two months and left because of the nasty environment - and I’m talkin’ the nurses here) was short two nurses and they were literally having people come in for 2-3 hour bits and pieces of shifts.

The nurse in me understood, but it’s funny, it doesn’t seem to matter when you are the family member/patient.

I’ll have to remember that.

Also, the ER docs are not allowed to write holding orders because the hospitalists want to see the patient in the ER, hence the nine-hour wait before we saw him.

For ten minutes.

John had been diagnosed with gallstones at approximately 1700. He was an automatic admit, especially with the hyperglycemia/newly discovered diabetes.

The ER doc should have written holding orders then - just basic diagnosis, bathroom privledges and NPO until evaluated. John could have been evaluated by both the hospitalist and the surgeon upstairs in a room. That’s how my ER does it and door-to-pt room is approximately 4 hours.

At this local-hospital-with-trauma-center, 14 hours ER waits were the norm. Ah, that’s another reason I don’t work there anymore, even though it is 3 miles from my home.

I should have known. It happened to me at the same hospital in 1990. Sixteen years later it’s no better? But that’s for another post.

I felt much better after A.J. and I talked. Although, she basically said the nursing care on this particular floor was not the best in the west, if I got her drift.

Great.

Oh, and by-the-way, all John had to do was sign a paper and I could have had access to the entire chart.

******************************

The surgery did not take long and soon Dr. God-the-Spitfire-Surgeon came out to let me know I could come in and see John in recovery.

She said that he should have been much sicker from the way the gallbladder looked on removal (UPDATE: two weeks later, at his follow-up appointment, John was told it was gangrenous - dodged that bullet! Good thing I was sitting and blogging when I heard the news or I would have had a syncopal episode on the spot!).

John has no memory of recovery - in fact he thought he had not even gone to surgery yet.

Oh, the joys of propofol.

Which means he has no recollection of the wonderful anesthesiologist giving him a great pep talk on taking care of himself so he could enjoy retirement, or, keep going the way he is and dying in 5-10 years! I heard it, so I was able to reiterate it to John, but I wonder if anesthesiologists know that their patients don’t remember what they say.

And that the families are eternally grateful for their expertise.

Now I figure I have the surgeon in front of me. Exhausted and writing her post-op orders and notes. I’d like to have a copy of the lab work, I say.

She can’t give me one. HIPPA. She’s not an employee of the hospital, so no-can-do.

I. Am. Going. To. Scream. Not at the doc. I’m sick of this bureaucratic S*** that won’t give me, a health care professional, access to my husband’s freakin’ labwork!

Like I’m going to use his bilirubin against him in a court-of-law or announce it to the world or use it against him the next time we have an argument!

Geeze.

After Dr. God-the-Spitfire said her goodbyes, the recovery room nurse with whom I had shared some, shall we say, nursing class experiences, wanted to know if I’d like to see, as a fellow nurse “how our facility puts their charts together”. Wink. Wink. And it happened to be open to lab section. Wink. Wink.

And darn it she accidentally made an extra copy for the floor! Ooops, better put it in the special bin for “patient confidentiality”!

Never heard my purse described that way before.

I won’t give the numbers, but let’s just say the “liver test” that was elevated was John’s bilirubin and it had doubled overnight, hence the decision to do surgery that day.

******************************

A.J. had done some work while John was in surgery.

The next day I found him in a double room, with no roomate, at the end of the hall. He had no roommate the entire time he was there. She must have said something to the nurses up there because when I came to visit the next night I heard whispers at the nursing station as I walked down the hall.

Or, maybe I’m just paranoid.

I still plan to write the CEO with a cc to the ER Medical Director, the Director of Nursing and the Nurse Manager of the floor John was on.

The medical care was perfect. 50% of the nursing care was perfect. But the system there needs some major improvements.

And yes, I have the names of the great nurses (and the ER doc) who introduced themseves and made things easier when they could.

I’ll start off the letter with their names.

After all, ya gotta give props when they are due, even if the situation as a whole was frustrating.

Next: Gotta Get Movin’!

Saturday In the Dark

Well excuuuuse me for interrupting the party!

If I had known radiology was such an exciting department I would spend more time there!

That woman looks just like my old 1962 Nurse Barbie, including the glasses.

The doc in the back must be an intern. He has either discovered his first pelvic fracture or he’s pointing to a very distended bladder.

And I’m pretty sure Grandpa Attending is old enough to have invented the x-ray.

Oh well.

What the heck do I know.

I can’t read an x-ray any more than I can read Russian.

I’m goin’ to the ER.

They have better parties there, anyway.

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You’ll notice a bit of a difference between this blog and Emergiblog. Because most of this blog is sequential, there will only be one post at a time actually on the blog, with the ability to go from one post to another at the bottom. Or, if you are like me, you like to read from the back to the front. That’s how I read magazines.

Don’t ask….

(Is it a faux pas to link to yourself? It feels too good to be legal….)

Oh, and everyone’s link is there at the bottom with room for more!

Thanks to my Super Webman (Shane) for the ideas and designs changes!

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I had last seen John in the Emergency Department the night before. I went home and finally fell asleep around 0500. John called around 0900 and said not to come in, that he just wanted to sleep as he had very little opportunity during the night.

After finally getting to his med/surg room at 0100, he was then “admitted” by his nurse, who proceeded to ask all the same questions that were asked by:

• The ER triage nurse
• The ER doctor
• Three different ER nurses
• The hospitalist
• The surgeon

He wondered if anyone talked to each other.

It took until 0300 to “settle him in”. And because he had no medication ordered for sleep, they gave him the morphine that had been ordered for pain instead.

(Dilaudid in the ER worked wonderfully. Why Morphine on the floor orders? Trust me, I give both everyday to dozens of people. Dilaudid is the God of All Narcotics. Hands down.)

At 0500 they admitted another patient to his room. So much for sleep.

******************************

I walked into the hospital room at 1300.

“What the HELL are you doing in a four-bed ward?” was the first thing out of my mouth.

Subtleness is not exactly my style.

My god, I didn’t even think modern hospitals even had those anymore! The room was packed. There were no chairs, so I sat on the end of John’s bed.

What about privacy laws? What about cross-contamination? What about the fact that this totally sucked? What about the fact that when I walked in there were no less than eleven people in the room, including the nurse?

******************************

A different hospitalist had seen John that morning and said that the surgery should be done that day. His already elevated “liver test” had doubled overnight and the surgeon needed to know. The gallbladder was soon to be history.

John had not slept all night and had only napped briefly that morning. I didn’t stay long. He wanted to sleep and said he’d call me when he had more informtion on the surgery time.

I waited at home for the call. Did some mindless chores. Answered endless phone calls

And then decided to run to Safeway. It took all of 20 minutes.

During which time, the surgeon called. John was going to surgery in half an hour.

I grabbed my book, some water and some crocheting and flew to the hospital.

Only to discover the surgery would not be for six hours.

Per John, the surgeon strode into the room, told him he was going to the OR in thirty minutes, picked up the phone in the room to arrange for the OR team to stay (this was Saturday) in house and then came the deadly pause when John said…..

“They’ve been feeding me all day.”

He was supposed to have been on clear liquids.

“Nevermind…” said the surgeon. SLAM! went the phone.

I found out later the petite little spitfire surgeon called the day nurse at home to find out just how the error happened and who was responsible!

God, I love that woman!

So, by now there were only two people in the room, and I settled in for the wait for surgery. By and by the nurse came in for a blood sugar check. John introduced us.

“Hi!” I said pleasantly. “By the way, I’d like to see a copy of the lab work that was done today”.

“Uhhh…..you have to fill out a form…..confidentiality…..I can’t let you see……”

John piped up with “Oh don’t worry, this is my wife, she has my permission to see the lab work.”

“Uhhhhh…..I have to go ask my charge nurse………confidentiality…….”

Five minutes later she came back with a form that I had to fill out, take to medical records (on Monday), pay $25.00 and then I could get a copy.

WTF?

Verbal permission from the patient was not sufficient?

Nevermind that 8 hours before at least four other people in the room heard the exact results that I was now denied access to.

Can you spell “H-I-P-P-A”?

I knew that they could.

Apparently the C-O-M-M-O-N S-E-N-S-E to know how and why it was to be used was not part of the equasion.

Like I said before, no one gave a damn that I was a nurse.

And then, the piece de resistance.

At 1900 they tried to give him his diabetic snack. Three hours before he was due to go to surgery.

I am slow to anger. It was starting to build.

On schedule, at 2130, John was taken to the OR.

While he slept the beautiful sleep of Propofol-ed, I sat in the lobby waiting.

And seething.

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Up next: God hath no fury like Kim when she is pissed off to the breaking point.

Wake Me Up Inside

This is a standing joke with my husband and I.

Our bedroom is right off the family room and my husband likes to come home from work and watch TV while laying on the bed.

As we have different interests in what we watch (me: British comedy, hubby: anything but), this is not an issue.

It has, however, given rise to one problem.

Hubby wants to be waited on.

Drives me nuts. “GET IT YOURSELF” is repeated so many times in my house I think my youngest daughter thought it was her dad’s name for years.

Now mind you, this is prior to his illness.

One day, as a joke, he asked me to bring home a urinal from the hosptial so that he would never have to leave his bed for anything.

He’s lucky I was just holding a pillow or he would have had a subdural hematoma that would have made a neurosurgeon quake.

But….now he actually has one.

A urinal, not a subdural hematoma.

He doesn’t use it, of course.

But I did offer to have it bronzed.

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Under stress, things become surrealistic.

Cholecystitis doesn’t not, as a rule throw me for a loop.

The diabetes diagnosis did.

I was so stunned by the sight of my husband in a hospital gown, either in pain or sedated, at first I was unable to feel anything as I waited. And waited. And waited.

Then came the dread. That heavy, sinking feeling that shoves your spinal cord against your chair and make every breath an effort. Worst-case scenario thinking. How long has he been diabetic? What damage has already been done? Amputations, retinal damage, renal failure, coma……

And the horrible realization that you have taken him for granted.

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I moved through various stages of emotions. Not the normal denial, depression bargaining, acceptance stages.

My brain stopped working.

If I wasn’t in John’s presence, I was crying. I couldn’t stop.

I did crazy things.

I ordered a 21-piece meal from KFC. For three people.

I went to get medication from my pharmacy. In a tank top I put on backwards.

I bought my elderly cat Tasha special cat food. She’s been dead for eight months.

I couldn’t focus on TV or conversations.

I felt overwhelmed. John was in no condition to discuss what he had been told or to even comprehend what was happening. I was exhausted but could not sleep. Family was calling from all over the west coast to see how he was doing. Every five minutes the phone rang.

In front of John, I was a rock of stability.

He asked me at least three times if the diabetes would go away when his gallbladder came out. And how they would cure it. He asked the same questions to every doctor that crossed his path.

I guess I did bargain somewhat. I had visions of me working full-time so that John would have less stress. That he should quit his job. That if I did this he would not die and I would not be a widow.

(Good grief, woman. The man has adult-onset diabetes and a rock in his gallbladder.

He isn’t at death’s door.

Pull yourself together.

“Dammit Jim, I’m a Nurse not a soggy mass of emotional blubber!”)

Oh yes I was.

As I drove home after midnight the day of admission, all I could think of was “write Amy….write Amy”. Amy runs DiabetesMine. She’d know. She’d understand.

She did and she does.

Later I realized that in a crisis I ran straight to a blogger.

Bloggers ROCK!

It’s a new world, folks.

And the next day, we were to discover just how screwed up this new world is where hospitals are concerned.