Choices

My travelling partner was not feeling well Monday. Her blood pressure was up when I checked it the other day, by machine and manually. She came in because we are short of staff. "This vertigo won't go away." she said. Yesterday, it was so bad, she went to the ER. They admitted her.

He was one of our regulars. A mustachioed man with a syrupy accent so heavy, I was occasionally called in to translate (because I'm good at translating) for the new nurses who don't recognize the  cadence and drawl from his part of the South. One nurse I worked with had known from the time he was injured. He knew our programs so well he could have taught them, she said. We were the safety net: if he got sick, he always came to us (even drove himself this time).

But he was more than sick:  he was septic, so the Hotel was not the place for him. We sent him on to Washington for more acute care, and he got worse. He survived some crazy cardiac stunts, but the last procedure set off a cascade from which he did not survive. His car sat on the parking lot when I arrived the other morning. The family came and picked it up yesterday.

Today, I read this story, passed along from one of my coworkers. He didn't want to live like many folks do at the Hotel. He just wanted to die, and with his family, he did. It was so sad because he chose to leave when his wife was  pregnant with his first child. "He'll never hold their child.", the article said.

He'll never see that child, either, or make a difference in his/her life. That is the part, to me, which is the saddest. I have worked with rehab patients who have raised children (yes, they need help), and they do parent them. They do discipline them. They do care, even if they cannot lift a finger.

The choices we make can change things forever.

Heard on the unit: Denial is not a river in Egypt

Nurse: Sir, are you on any blood pressure meds?
Patient: No, none at all.
Nurse: Your blood pressure is really high (systolic near 200, diastolic 110). I'm going to have to call the doctor and get an order for you. (leaves room)

Nurse on phone and tells Doc story about Mr. HTN above.
Doctor: Mr. HTN is non-compliant with his blood pressure meds.
Nurse: He has a history? He's denied it to everyone who's come into the room.
Doctor: That's nothing new. Give him xx BP med now, and I'll come to see him.

A nice surprise for the morning...

A pretty good day

I was lucky enough to have my three same patients back and my day was reasonably easy. The Slug was coordinating our Boss's Day festivities, so it was pretty haphazard as I expected, and she disappeared for not just one plus hour, but two and a half hours. Heaven forbid you actually do this stuff on your OWN time!

I got Mr. B. ready and he kept having orthostatic hypertension. He'd get set up in his chair and in an upright driving position and his BP would just plummet. I had no choice but to contact the NP. He kept dropping in spite of his TED hose, abdominal binder and his 5 mgs of Midodrine. I got an order for another 5 mgs of Midodrine at lunch time and he did well, but he got woozy again on me late in the afternoon as I was leaving. I passed this on to the evening shift. Tomorrow, I get to go with Mr. B. up to Washington to see the neurosurgeon. They will do some flexion-extension x-rays to determine if he can get his halo removed.

The other Mr. B. got back from his trip to Washington without a hitch. The GI docs found a cancerous polyp on his last colonoscopy and were looking for the area where it was removed today. They searched his entire colon and could not find it, even though he had a tattoed polypectomy last time.

Mr. W., my other patient, a para who did all of his own care left today. He was very nice and was very happy that his colonoscopy didn't show anything bad at all. I put in his discharge notes and wished him well.

The afternoon went reasonably well. I got my hotel confirmed for the conference I'm attending in November. I'm still getting the flight situated. I missed two Accuchecks at lunch time because two of the diabetic patients escaped to the free lunch one of the veteran's organizations has each month. I managed to get all the Accuchecks done before anyone ate anything else and I escaped at 1600. Fall is definitely here in our neck of the woods. It was blue skies and sunny, but the wind was cool and crisp.

More later...

Nuggets for March 26

Here are the latest articles of note I've read recently.

Night shift, sleep deprivation may be hazardous to health (from the LA Times)
More and more articles are discussing research into this very important issue.

High blood pressure runs in families (from Yahoo!News)
Another interesting study about hypertension.

Hospitals go automated (from kansas.com)
One hospital group's take on automation