This article from the Wall Street Journal made me drudge up thoughts about some of the Hotel patients and other surgeons.
One patient had a common ailment that we see at the Hotel. It is always has the potential to be dangerous, even when it doesn't appear to be. It hides in the body and while we see the disfiguring side in nursing, mostly pressure sores, it's an illness that often requires the participation of multiple disciplines, ranging from plastic surgery (our most common), infectious disease, orthopedics, and sometimes even hematology/oncology.
People want to know what will happen and when one particular doctor gave his take of the situation, they called him "Debbie Downer". I explained to the patient (and the relatives) that this is not to scare them, but to tell them the truth. Informed consent really is a good thing, and sometimes, I spend way more time talking to patients after they hear life-changing news, and they ask the what, where, and why questions. Often, they just don't want to believe that one doctor.
However, our surgeon wasn't the only one. He also consulted with orthopedics. The patient was offered a procedure that was not acceptable. The other option was two different procedures: a hemipelvectomy or a girdlestone, but the patient wouldn't consent to those, either.
Our surgeon took the patient to the OR, since he/she agreed to the odds. The odds were not on their side. There was no miracle. The procedure could not be completed. We are pretty much where we started.
Now we wait to see what happens. Some things are just not what they seem, so being informed is a very good thing.
Showing posts with label hemicorpectomy. Show all posts
Showing posts with label hemicorpectomy. Show all posts
Sunday, May 24, 2015
Saturday, September 20, 2008
Fun Friday
This happens when one, the census is down, two, both of your patients have doctor's appointments at the same time and three, you are not working the weekend. Oh, what joy!
That was my day yesterday. I felt like I actually accomplished something. I had two patients all day. My patients got a clean room, which was wonderful. I kept picking up my mess as I made it when working on my patients' dressings, etc., but some other nurses did not. There were wrappers and saline flushes and IV blue rubber stoppers and Tempadots all over the floor will-nilly. There were even some of these said items in one patient's bed. Arrgh! This is the same man who is a trainwreck in terms of skin integrity (massive sores--two out of four are unstageable), tubes galore and psych issues on top of everything. Let's just give him one more thing to mess him up! (Yes, I'm being facetious...)
Once both patients were out, I got the antibacterial, it-kills-everything wipes and wiped down their low-airloss mattresses. I did them well enough so that they actually stayed wet for the required two minutes. This requires a few wipes, but I had them. After that, I picked up all the stuff I could on the floor, including Mr. AB #1's case of 20oz. Sprite bottles, so the housekeeper could sweep and mop everywhere. He surely did. He did everything but burnish (aka super wax) the floors and that would have required both patients be out of the room most of the day. He was still working when AB #1 came back, so I had an even better excuse to keep him up and out of the room.
Mr. AB #1 stays in his room all day because of his sores. He's to be turned and repositioned every two hours, but often, he refuses to turn. This is really bad when you have the sores he has. The docs have been trying to figure out a way to get him up on a stretcher for an hour a day to just get him out of the room. (We put these patients on Roho mattresses or waffle air mattresses while on a stretcher). I tried selling him on going outside Thursday and he refused my offer. The neuropsych came in and she talked to him about going out of his room. Still, he refused. I thought about it, and when I talked to the neuropsych later, I told her about my plan to keep him out of the room...nothing like a little subterfuge. My plan: say the bed is not working. If a no-airloss mattress is not working, you can't put someone in it, since they sink like a rock. She thought this was a great idea. I told the other MDs and they went with it, too. I even told my boss that was the plan, so no one would goof up and tell Mr. AB #1 that it was not true.
The housekeeper was a great backup. He played along, too, and kept on cleaning. He was the real, physical excuse why I couldn't put AB #1 back in his room...whoops! He's still cleaning, I said, with his massive stainless cart and buckets galore, so the ambulance drivers put him in the TV room where I had a stretcher waiting. We got him on the stretcher and then he talked to the docs about his appointment. I set him up with a bedside table and some Sprite which was in the room. (No one is in a hurry to leave if they have a drink or snacks, I've found.) Apparently, it went better than what they had thought it would. His prognosis is still not the best, but if he keeps gradually improving, he may avoid the draconian measures we know in which he refuses participate, which could include amputation or worst of all, his lower body, in a hemicorpectomy.
All in all, Mr. AB #1 stayed up for an entire hour before I put him back in his room. His neighbor, Mr. AB #2 came back at around 1030 and I snuck out and checked him out and changed his dressings before I got AB #1 back in the room. I also primed and set up his feeding pump, so he'd be ready. I really like those Kangaroo e-Pumps. They are so user-friendly compared to our other pumps, and the water flush has it's own bag. No stopping to remember in four hours that the patient needs his water flush. It is such a time-saver! Now if they could get it to use 1000cc bricks, it would really be ideal (We use the bags and cans of formula).
Mr. AB #1 needed his dressings changed, too. The residents do the dressings when they do the debridement, but they never last very long after the ride back to Madison. Mr. AB #1 was leaking all over, so I just re-did his dressing so it would last until evenings changed it again. Mr. AB #2's was changed, too, but one hip started draining out of the dressing.I reinforced his, because I didn't want to disturb the packing again. He had some clots and is prone to draining, so this was the better solution and the NP and my collegues concurred.
I kept the guys fluffed and buffed. Mr. AB #2 even got a haircut when I saw the beautician on the unit. In theory, she's supposed to be coming every Tuesday, but since I was off, I didn't know if she had be on the unit. Once I saw her, I talked to her about AB2 and she did. He was thrilled with his haircut. Once she was done, I set him up and washed his hair and changed his shirt. "I feel like a new man!" he said.
Finally, I finished my day doing paperwork and hanging out at the front desk. It wasn't bad at all. Now it's time to cram everything into the weekend. Dahey is working this weekend, so Bubba and I will be keeping busy. Stay tuned for more next week!
That was my day yesterday. I felt like I actually accomplished something. I had two patients all day. My patients got a clean room, which was wonderful. I kept picking up my mess as I made it when working on my patients' dressings, etc., but some other nurses did not. There were wrappers and saline flushes and IV blue rubber stoppers and Tempadots all over the floor will-nilly. There were even some of these said items in one patient's bed. Arrgh! This is the same man who is a trainwreck in terms of skin integrity (massive sores--two out of four are unstageable), tubes galore and psych issues on top of everything. Let's just give him one more thing to mess him up! (Yes, I'm being facetious...)
Once both patients were out, I got the antibacterial, it-kills-everything wipes and wiped down their low-airloss mattresses. I did them well enough so that they actually stayed wet for the required two minutes. This requires a few wipes, but I had them. After that, I picked up all the stuff I could on the floor, including Mr. AB #1's case of 20oz. Sprite bottles, so the housekeeper could sweep and mop everywhere. He surely did. He did everything but burnish (aka super wax) the floors and that would have required both patients be out of the room most of the day. He was still working when AB #1 came back, so I had an even better excuse to keep him up and out of the room.
Mr. AB #1 stays in his room all day because of his sores. He's to be turned and repositioned every two hours, but often, he refuses to turn. This is really bad when you have the sores he has. The docs have been trying to figure out a way to get him up on a stretcher for an hour a day to just get him out of the room. (We put these patients on Roho mattresses or waffle air mattresses while on a stretcher). I tried selling him on going outside Thursday and he refused my offer. The neuropsych came in and she talked to him about going out of his room. Still, he refused. I thought about it, and when I talked to the neuropsych later, I told her about my plan to keep him out of the room...nothing like a little subterfuge. My plan: say the bed is not working. If a no-airloss mattress is not working, you can't put someone in it, since they sink like a rock. She thought this was a great idea. I told the other MDs and they went with it, too. I even told my boss that was the plan, so no one would goof up and tell Mr. AB #1 that it was not true.
The housekeeper was a great backup. He played along, too, and kept on cleaning. He was the real, physical excuse why I couldn't put AB #1 back in his room...whoops! He's still cleaning, I said, with his massive stainless cart and buckets galore, so the ambulance drivers put him in the TV room where I had a stretcher waiting. We got him on the stretcher and then he talked to the docs about his appointment. I set him up with a bedside table and some Sprite which was in the room. (No one is in a hurry to leave if they have a drink or snacks, I've found.) Apparently, it went better than what they had thought it would. His prognosis is still not the best, but if he keeps gradually improving, he may avoid the draconian measures we know in which he refuses participate, which could include amputation or worst of all, his lower body, in a hemicorpectomy.
All in all, Mr. AB #1 stayed up for an entire hour before I put him back in his room. His neighbor, Mr. AB #2 came back at around 1030 and I snuck out and checked him out and changed his dressings before I got AB #1 back in the room. I also primed and set up his feeding pump, so he'd be ready. I really like those Kangaroo e-Pumps. They are so user-friendly compared to our other pumps, and the water flush has it's own bag. No stopping to remember in four hours that the patient needs his water flush. It is such a time-saver! Now if they could get it to use 1000cc bricks, it would really be ideal (We use the bags and cans of formula).
Mr. AB #1 needed his dressings changed, too. The residents do the dressings when they do the debridement, but they never last very long after the ride back to Madison. Mr. AB #1 was leaking all over, so I just re-did his dressing so it would last until evenings changed it again. Mr. AB #2's was changed, too, but one hip started draining out of the dressing.I reinforced his, because I didn't want to disturb the packing again. He had some clots and is prone to draining, so this was the better solution and the NP and my collegues concurred.
I kept the guys fluffed and buffed. Mr. AB #2 even got a haircut when I saw the beautician on the unit. In theory, she's supposed to be coming every Tuesday, but since I was off, I didn't know if she had be on the unit. Once I saw her, I talked to her about AB2 and she did. He was thrilled with his haircut. Once she was done, I set him up and washed his hair and changed his shirt. "I feel like a new man!" he said.
Finally, I finished my day doing paperwork and hanging out at the front desk. It wasn't bad at all. Now it's time to cram everything into the weekend. Dahey is working this weekend, so Bubba and I will be keeping busy. Stay tuned for more next week!
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