First. While I don’t dispute that Scrapper needs a med change and/or a muzzle, I’ve decided I’m not responsible for what results when the Voices get a hold of my Mac Book Pro. If doctor’s have no control over the care of their patients in the hospital….
Nevertheless, I am working on the anger. I’ve always believed that Anger is nothing more than a symptom, and it’s best to treat the cause rather than the symptom. In order to diagnose the cause of anger I make myself the defense attorney. It gives one a different perspective, broadens understanding and fosters forgiveness.
I have spent the past few days building a major defense on the incorrect dosing of Rich’s diazoxide.
After all, your Honor, the defendants are only human, not to mention overworked, and let us not forget that we only have the victim’s word that he was started on the bottom line of the dropper and never received more than one full dropper. Let us not forget that he was severely sleep deprived AND hypoglycemic—hardly a reliable witness that would hold up under cross-examination. It seems obvious here that the real question is “Where was the Wife?” It’s hard to credit any true concern when she was seldom at his bedside Monday through Friday, and never once questioned what the nursing staff was doing or giving. Why wasn’t the Wife demanding to see his med list? Requiring staff to demonstrate their dosing methods and calculations? Ultimately, isn’t the Wife responsible for his care? If she chooses to put her job and fiscal responsibilities above her husband’s care she can hardly expect others to cover for her neglect.
Thank you, your Honor. I rest my case.
At which point I had a three hour cry that ended around 9 am this morning. Not convenient, but necessary.
Now that my anger has evolved into guilt I can move on. Not that I ever intended to cause anyone any grief over this. I’m not stupid. No matter how high I might jump ugly, the most that would happen is that one or more nurses would get written up, and that is not what I want and NOT the way to prevent this from happening in the future.
The real problem here is that people with no concept of patient care are making the decisions about patient care, i.e. staffing. These decision makers will NEVER experience the results of their decisions, and I know this from experience, because if they or one of their family members is ever a patient, the Ts will be crossed and the I’s will be dotted, and staff will work their asses off and shit through their ribs to make sure Life is Perfect for them. I know this because I have witnessed this phenomenon first hand, more than once.
It is much the same as Congress determining our health care when they never have to experience it for themselves because they have their own “special healthcare”. La-de-da, la-de-da.
Second to the guilt, I’ve discovered that the cause of my anger is feeling betrayed and abandoned. Not to say that those feelings are reasonable or justified, but thank the goddess, feelings don’t have to be reasonable or justified. They just ARE.
To even attempt to tell you what life with cancer is like is just plain ignorant. Either you already have the relationship, in which case I can add nothing to your knowledge, or you don’t have the relationship , in which case nothing I say can create a whisper of the image for you.
I WILL tell you that fighting cancer is hard enough without getting hit from behind by the people that you trust to have your back. I look up to RNs the way an apprentice looks up to the master craftsman. The RNs I’ve worked with have been my best teachers and I love them like family. They set an example of what a nurse should be. So whenever Rich was in their care, I stepped back with trust and respect. I knew they were caring for him the way I would care for their husband. I was trained to check every dose three times before giving it. “You do not blindly trust anyone to determine the dose you give. It is on you. You follow the doctor’s orders and you do the math and YOU are responsible.” That was the mantra my nursing instructors drilled into my brain. I live by it.
I happen to love White Stripes. One of their songs has become a terminal loop in my brain...."NURSE" Check it out.
My anger is the symptom of feeling betrayed. And scared. If I can’t trust the nurses responsible for his care in the hospital, and the doctor’s have no control over their orders being carried out… then I am truly alone. I was able to fight because I believed we had a team that was fighting with us and for us. Not only do I find myself alone in this fight, I can no longer trust my team.
My brain keeps flashing to the end of “Thelma and Louise”. When they realized it was just the two of them, and no one was going to stand up for them, they took the cliff. NOW I get it.
Calm down. I’m not suicidal. Trust me, I’m not the kind who telegraphs such intentions. If I were really about ending it all, no one would know till it was over.
My favorite movie line of the day….
“We’re all alone out there, and tomorrow we’re going out there again.”
Anyone? Anyone? William Hurt, The Big Chill.
Thursday, December 8, 2011
Tuesday, December 6, 2011
How about we try remedial math....
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.
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.
Sunday, December 4, 2011
Day Two at home with the Cure
Home friday night; and I refuse to divulge how I managed to give him the 11:30 pm subcu injection. Suffice it to say, I made it happen.
Saturday went....o----kay? At 09:30 am I awoke in a panic, realizing that he had reneged on his promise to take the 4 am watch. Holy crap was I pissed. I scrambled to get his blood sugar, a high protein breakfast and his 08:00 injection. I now have blisters on the inside of my lip from biting it. I have a long fuse, but it gets real short when someone is jerking it. Finally I looked at him and softly said,
"So this is how it's gonna roll? I'm gonna wait on you hand and foot all weekend and work and worry all week?" I left the room before he had to come up with a half-assed answer that would have only poured gasoline on the burning coals. Color me stupid but I trusted him to get the point.
He did his best the rest of the day despite that he's still recovering from sleep deprivation. I would love to nurse him every minute but that's not going to get him where he needs to be so that I can go back to work on Monday. Seriously, dude, if you can find a call light attached to your bed, you go right ahead and try it. Let me know how that works for you.
Oh my gawd, I sound like a Bitch.
At 6:30 pm I fall asleep on the couch after working all day cleaning, cooking, prepping to be gone Monday through Friday. At four am this morning I wake to the sound of footsteps on the stairs. I can barely form words. "Are you okay?" (if I had a quarter for every time I've asked him that) Yeah, he's just getting his 4 am snack. Stupid me, I have to ask what his blood sugar is....
41
I felt a sudden stabbing sensation in my brain. Three brain cells fired and screamed at me to GET UP, YOU ASSHOLE, AND FIX THIS!!!! The voices in my head out-number three panicked brain cells. I turned over, as well as one can on a couch, and went back to sleep.
I woke up at 08:30 this morning and ran upstairs to ask "are you okay?" He wakens easily and says yes. I want to go back to sleep, but maybe twelve plus hours is enough, and then I realize we're late for morning meds, blood sugars and a HIGH protein breakfast. I kick it into gear and in twenty minutes I've got Irish oatmeal, whole grain toast and 10 oz of milk on a tray with his subcu injection. First his blood sugar, which is 157. Fuck me very much.
All it takes is one low blood sugar to totally shake the foundation of my ease. At this point, it is not possible to stop my brain from running the gamut of every possible parallel universe I might enter. I have to remain calm and make this okay. I have to be ready to call 911 and warn the ER not to touch him when we get there. Worse... when I explain why we're back, someone is going to ask.... "has he been taking his medications correctly?"
Within 27 seconds of my hearing THAT question, one of two things will happen.
1) I will scream "the medications you gave us without THE gawd=damned syringes required to inject it?????? someone will then be calling Security with a very shrill tone of panic in their voice,
OR
2) I will kiss my husband, smile and nod to everyone in the room and leave without a word. I will wander out into the night, weaving past the hive of ambulances around the ER entrance until I reach the sidewalk. I will walk off into the dark cold night, camera still for shot of me walking away, go to black, The End.
Planning is good. It doesn't have to be a GOOD plan. Sometimes you just need a plan.
Saturday went....o----kay? At 09:30 am I awoke in a panic, realizing that he had reneged on his promise to take the 4 am watch. Holy crap was I pissed. I scrambled to get his blood sugar, a high protein breakfast and his 08:00 injection. I now have blisters on the inside of my lip from biting it. I have a long fuse, but it gets real short when someone is jerking it. Finally I looked at him and softly said,
"So this is how it's gonna roll? I'm gonna wait on you hand and foot all weekend and work and worry all week?" I left the room before he had to come up with a half-assed answer that would have only poured gasoline on the burning coals. Color me stupid but I trusted him to get the point.
He did his best the rest of the day despite that he's still recovering from sleep deprivation. I would love to nurse him every minute but that's not going to get him where he needs to be so that I can go back to work on Monday. Seriously, dude, if you can find a call light attached to your bed, you go right ahead and try it. Let me know how that works for you.
Oh my gawd, I sound like a Bitch.
At 6:30 pm I fall asleep on the couch after working all day cleaning, cooking, prepping to be gone Monday through Friday. At four am this morning I wake to the sound of footsteps on the stairs. I can barely form words. "Are you okay?" (if I had a quarter for every time I've asked him that) Yeah, he's just getting his 4 am snack. Stupid me, I have to ask what his blood sugar is....
41
I felt a sudden stabbing sensation in my brain. Three brain cells fired and screamed at me to GET UP, YOU ASSHOLE, AND FIX THIS!!!! The voices in my head out-number three panicked brain cells. I turned over, as well as one can on a couch, and went back to sleep.
I woke up at 08:30 this morning and ran upstairs to ask "are you okay?" He wakens easily and says yes. I want to go back to sleep, but maybe twelve plus hours is enough, and then I realize we're late for morning meds, blood sugars and a HIGH protein breakfast. I kick it into gear and in twenty minutes I've got Irish oatmeal, whole grain toast and 10 oz of milk on a tray with his subcu injection. First his blood sugar, which is 157. Fuck me very much.
All it takes is one low blood sugar to totally shake the foundation of my ease. At this point, it is not possible to stop my brain from running the gamut of every possible parallel universe I might enter. I have to remain calm and make this okay. I have to be ready to call 911 and warn the ER not to touch him when we get there. Worse... when I explain why we're back, someone is going to ask.... "has he been taking his medications correctly?"
Within 27 seconds of my hearing THAT question, one of two things will happen.
1) I will scream "the medications you gave us without THE gawd=damned syringes required to inject it?????? someone will then be calling Security with a very shrill tone of panic in their voice,
OR
2) I will kiss my husband, smile and nod to everyone in the room and leave without a word. I will wander out into the night, weaving past the hive of ambulances around the ER entrance until I reach the sidewalk. I will walk off into the dark cold night, camera still for shot of me walking away, go to black, The End.
Planning is good. It doesn't have to be a GOOD plan. Sometimes you just need a plan.
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