The Elderly...Dogs that is

We have an older dog. It is much like having an elderly parent or a small child. We have to shake her food for her to find it some days, raise our voices to make sure she hears us and sometimes she walks into things. I don't see signs of pain, so I can't bring myself to do anything but give her extra love right now. I am worried about this winter when her arthritis acts up, but hopefully we can control that with meds.

We've always called her an "old lady in a dog suit" because she has always been persnickity. She was a gift from my parents, besides the house one of the last things I have that I inherited. Yes, the house, a cat and a dog. And Ginger knows that she has lived her longer than us. A few months ago she decided she would no longer sleep in the laundry room, I gathered that it was her house and she was now sleeping in the master bedroom, we could adjust. You know, we did. When I figure this thing out, I will post a picture of her. The other dogs are border collies and so she has had to adapt to them. Actually she made them adjust but she also trained the children.

Isn't life funny, we have the dogs, the cats own us, and God made it all.

Return from the Abyss

Three days of work, and they got their money's worth out of me this time. I'm not one of those that just sits around well, but some days we have a little more time to get things done. This time was not one of those. I don't think I left on time once, and that was with folks helping me. Thursday I got a little man down from the floor in respiratory distress, we intubated three hours later because he was stuggling so much and sats were not so good. It's always hard when you go from having a patient that is talking and you get to know them a little bit, then you sedate them and even know that you may never talk to them again. We were able to wait on his wife to come back before we intubated so that they could be in agreement with the decision to intubate.

This man went from bad to worse. I can't believe he made it to Sunday. When you see ICU nurses excited about a sat of 80% you know it's bad. I had so many drugs going, I was using a mix of central line and PIV's to have enough places to put things. He was so unstable, we couldn't bathe him, turn him or anything. The doctor that was primarily treating him came in to see him even though he was off this weekend. The family was touched. At any rate, so far so good. Between losing one lung to cancer, now the other has ARDS, this guy barely has a chance. For those that know me, they are amazed b/c I've got the reputation as the "angel". Of course, some times we get lucky and the power shifts to another for the day.

Another treat for the weekend was both my families gave me treats!! Yeah! Feed the nurses!! Chocolate ROCKS! This was a good weekend for me to get chocolate, between the stress and other stuff, one friend loaded my pocket with the instructions that when she commanded I was to get some. And you know, it worked well, I started getting a bit stressed, she'd look at me, say "eat chocolate" and low and behold, it was doable. :) I love my friends, I love my patients and most of their families. *giggle*

Better Living Through Chemistry

The procedure went well. The alien ployp was removed without difficulty (well, as far as I know). Versed and Fentanyl are a wonderful combination. I love them. The last thing I remembered was the pat on the arm after "hello". Very smooth trick that doc did!!! And no complaints on my part. As far as having a colonoscopy, if ya gotta do it, this wasn't too bad.

Tomorrow is the return to work, 3 days of forced labour, however I shall give it my all. I do enjoy the folks I work with. I've not had anyone comment about how others do withdrawing of care, but I really do want to know how it's done across the country or world for that matter. As I gain trust in this thing I'll talk more about my feelings on these things. In my work I'm known as the "angel" in our department, it seems as if people are ever going to decide to let their loved ones go or if the patient is just going to go, it happens to me. At times, I didn't even say anything. One case, the patient was literally having parts of his body rot and his mother wouldn't allow him to be removed from life support (he was not a young man either, just no other family). The first day I cared for him, she came to me after visitation and said she wanted support removed. I called the physician, recieved orders, called his friends to come and sit with him. After the friends had time alone, when they were ready, I removed the support and he quietly passed away. While it was what needed to happen for this man, I never said anything to the mother about it. I've been told that I have a comforting way about it, I don't know. Some days it's hard to do it, yet I would rather it be me, because I know I will pray before I remove support, and I will medicate to be sure that the patient doesn't suffer, and I do care for the families around me. Death is very difficult, yet sometimes the families need to realize they can't stop hurting until they allow the patient to go. I'm never in a rush to see it, because you should be sure that this is the right thing to do, but someone must care enough to help the families. Thoughts???? And yes, I'm very much respectful to life, very much opposed to euthenasia.

The "Procedure"

Okay, I'm soooooooo excited. On Tuesday I get to have a garden hose run up a place where they aren't supposed to go. In fact, very little is supposed to go there. I've had this test before, never particulary cared for it and would rather not do this one. However, I'm not real interested in finding out that "gee, with your family history you should have known this was coming". Now, I'm a critical care nurse, I've helped with these. We do them in the unit on those poor folks that are to ill to go down to the "dark side of the basement". My selection of physicians to do this was actually based on two critieria: one, that the nurses that work in the dark side approve of him and two, that he not be one of the ones I see on a daily basis in the unit. There are some very good ones that come in a lot, and I adore them, however, I'm a touch on the shy side.

Now the next part of that is that I'm already starting the clear liquids. Yes, a little early, but I'm paranoid about not being clear on time. Seems I've had trouble with that in the past. As I was making the Jello today I'm seriously thinking about Jello shots. Oh to have at Fat Doctor advise me on this: would it be acceptable? But on the downside I'm thinking that I couldn't drink enough to last till the procedure is over. He's planning on Fentanyl and Versed. I'm worried about the Fentanyl, I mean, the patients I see that have had that wake up kinda quick. I want to be out longer and like, close to needing a vent. I really, really, really don't want to be awake at ALL for this. I've had other things and basically suggested they just give enough Valium to be able to catch me, talk to me and tell me jokes through the procedure and I'll be fine. NOT THIS TIME. I am a wienny about it.

Then a couple of ladies (the new ones) at the church have discovered the "procedure" is coming but have swore not to mention it to the spouses. See, I'm kinda "returning" to the fold and still not sure of myself around these folks. One of the men spoke to me one day and I had a panic attack - silly, no clue why. I mean, had he dropped to the floor dead I would / could have saved him. Without thinking. So why have no confidence here, not a clue. But, all that is another day. Well, vacation is officially over, must school the kid tomorrow and prepare. Oh joy!!

tigspeaks

HELP.......
I need some help please. For anyone reading this that is medical. How do you, in other parts of the universe (since I have only said I'm in the south - and actually anyone here as well) deal with end of life issues in your hospitals or units (I'm in Critical Care). Specifically if you are withdrawing care on a patient. I will eventually address a recent issue that I had to deal with, but still trying to decide how much I can share. Overall, a physician I don't think should have given withdrawal orders did, and wanted to give more medication than would have been neccesary to provide "comfort" while the ventilator was withdrawn.

The other thing is, compared to most of the blogs I've looked at, mine sucks. Ideals????

Thanks..

tigspeaks

VACATION: We are on day 4 of vacation, and day 4 of maybe I'll get the house clean today. So far, well, not so good. There was a time when I could clean a house in about three hours, but it wasn't my house and my junk in the way. Today the goal is to put the ipod on, crank it up, clean, then go eat lunch (which I have done a lot this week).

Yesterday I blew about an hour trying to figure out which songs I wanted to add to the ipod, one day some anthropologist is going to come along and try to figure out what we were like based on our music. My ipod has the Archies "sugar sugar" Keith Green "So you want to go back to Egypt", and I'm going to add Scooby Dooby do. Well, I can't even figure me out. I mean, Dave Matthews Charlie Brown theme is awesome.....

Okay, taking off the shoes, putting on the ipod.... sending the kid off to homeschool academy for the day. Kicking the dogs out of the way, avoiding, avoiding, avoiding......

Another day of vacation shot to heck

tigspeaks Today was day two of vacation. I spent it doing school with the remaining child at home, then lunch with the pastors wife, then kid to doctor (that shot a couple of hours). We did get to go out for dinner, spouse's birthday. He totally enjoyed the present - itunes gift card and time with the boys (these guys are 22, 19, and 16 - we don't get much time with them).

I've been reading some of the blogs, I'm working on trying to put my thoughts down but trying to figure out how I want to get there. Anyway, the nice thing about vacation was being away from the unit, but then, they called today to tell me how bad it was. I really don't mind, I'm thankful for my friends and that they trust me enough to vent. Sounds like it was horrible, a day where there were very few really experienced nurses and sick patients. But, in the modern world of nursing, this is where they get experience. The patients survived, the nurses survived. Well, we are noticing there are some that may need to find another area to work in if they can't get it together. But, time will tell.

Tomorrow is another day, need to clean, have lunch with yet another friend, and do school with the kid. Hopefully he will get educated in spite of who his teacher is.

tigspeaks

I have a day off, and what do I do..... hmmm, went to Wally World x 2, kid to homeschool academy, nap, McDonalds, and waiting to retrieve kid. I can't believe it. Oh, and called work twice. What about the fun things we are supposed to do? What is wrong with me. I have several good books to read, studying to do, and lets see....... life waiting to happen. Geez.

I've also reviewed some blogs, looking to see what other real people do with their time. Seems the lack of sleep isn't unusual for medical folks, the desire to lay around is commn. Maybe I am normal. Next week I'm off for the whole week, I plan of listing some of my favorite stories so that I can have them down for memory sake. There's an ethical question I would like to throw out if anyone care to look at it. All in all, I really hope to read a lot. Oh, I guess I will also have to homeschool the kid as well. But still, no work. *giggle*. I also need to learn how to jazz up these posts.