If there are 50 milligrams per milliliters of diazoxide and the doctor has ordered the patient to get 250 mg…how many mL should the patient have?
Take your time.
Now. If the fill line on the dropper that comes with this oral med says 50 mg, how many dropperfuls would the patient need to get for the 250 mg prescribed dose?
Take your time.
Now. The reason I have posed this remedial math question is because I don’t want to appear too harsh. Let me explain.
During Rich’s discharge, the RN went over his home going meds and dosing instructions. When she got to the diazoxide she told him he was to get 250 mg once a day and that would be one full dropper. Rich verbalized understanding, including “Yes, that’s what they’ve been giving me.” The RN nodded. Fool that I am, I did not demand to examine the bottle. When will I learn?!
I have had no reason to examine the bottle because Rich takes his diazoxide at 10 pm and I go to bed at 8 pm.
Last night his endo doctor called to check on him and based on his blood sugars at home and some lab results, she wanted to change the dosing on the diazoxide. I wrote down all her instructions, and we finished our call. In order to make sure I got the dosing correct, I examined the bottle. Three times I compared the label on the bottle to the discharge instructions because of course an LPN is never going to be smarter than an RN. The label said 50 mg/mL. The dropper had a fill line that read 50 mg. I give enough injections to know that there is NO way that one dropper could hold 5 mL.
Again I asked Rich, “how many droppers of this did you get in the hospital.”
“One, “he said, “250 milligrams.”
Really?!?!?! Really. you fucking kidding me. (Question mark intentionally omitted.)
But wait. There’s more. Before the Endo doctor called the house to talk to Rich, Dr Kelli Peiffer, our PCP, called ME on my cell phone. Information was just now starting to trickle in to her office and she wanted to know who his cardiologist is, because she wanted to know why he’s still on the metoprolol. I explained that they used it in the hospital last year when he was septic and his heart rate was >120. When he recovered I asked them to stop the metoprolol but they wanted to keep him on it.
Dr Peiffer then explains that because it’s a beta-blocker, it’s going to mask any symptoms of hypoglycemia. Nice. She’s thinking that maybe if it’s okay with the other doctors we could start weaning him off the beta-blocker and give him more of a fighting chance of staying on top of the low blood sugars.
My head wants to explode. So when I call the endo doctor back because Rich can’t find the information she wants, I mention the metoprolol, and in a very round about way she explains that non cardiologists do not question the work of cardiologists. And here I thought surgeons were at the top of that food chain.
Once again Dr Peiffer figures out a glaring medication problem. Despite the fact that she’s Rich’s PCP, her main source of information is this blog. She is the only one of his doctors who asks me anything. Apparently a sleep-deprived hypoglycemic is a better source of information. Oh dear. Do I sound bitter?
After the phone calls with the doctors and the mental meltdown on discovering the dosing error on his diazoxide, I am returning a call to Christy when I realize that Rich is sitting on the couch, holding his glasses 10 inches in front of his face and asking me for the ninth time “what’s wrong with my glasses, I can’t see anything.” The tenth time he asked me, he started slurring his words.
I tell Christy what’s happening and hang up.
I can take a blood sugar at warp speed while simultaneously pouring a glass of milk and force feeding a high protein snack.
Forty minutes later he was himself again. Christy shows up with food and stays the night, working on her computer while keeping an eye on Rich so I can go to bed.
Today I tell the endo doctor about the dosing error, just because I think it’s something she needs to be aware of. Her response is that she can’t control what goes on in the hospital. Okay. Maybe we should find someone who can. Because here’s the deal. You can’t fire 72 LPNs, replace them with 20 new RNs and think patient care is not going to suffer.
Don’t piss on my shoes and tell me it’s raining.
It's absolutely true. Rich is himself, his wonderful self, until he suddenly scares the hell out of Lisa (and me, when I am rarely there) when he takes a turn, through no fault of his own. The other night, we examined the evidence: a tiny dropper, like a million I've seen from the vet's office to dose a small cat -- uh, twice a day.
ReplyDeleteAll this time, the "homecoming instructions" for Rich were wrong. Off by a tiny dollop? No! Jesus. Less effective than a baby aspirin. How can a doctor be "helpless" to rectify this? A sense of buck-passing lies in the air like a fog. I know many doctors fear stepping on others' toes, but this was likely an nurse's (or nurses') mistake, and no one will gainsay it?? Lisa is right on. She and Rich deserve better than to be left alone with unnecessary side effects of overworked medical people, who had failed to give the proper dosage of the drug of the week, and then no one will have the courage to rectify it.
Pissing on shoes? This is Lisa's fourth pair, at least. Maybe all she needs for Christmas are more shoes. (Do I sound bitter? Well, I've seen it. And the magma grows in me, as these unnecessary events transpire.)
God bless you both for having the strength of Atlas. In the face of ignorance, ineptitude, exhaustion (by nurses with no assistants), and whatever else these people are thinking (or not). I think I am more pissed than bitter. Will have to work that out.