Always remember...

These heroes are dead. They died for liberty - they died for us. They are at rest. They sleep in the land they made free, under the flag they rendered stainless, under the solemn pines, the sad hemlocks, the tearful willows, and the embracing vines. They sleep beneath the shadows of the clouds, careless alike of sunshine or of storm, each in the windowless Place of Rest. Earth may run red with other wars - they are at peace. In the midst of battle, in the roar of conflict, they found the serenity of death. I have one sentiment for soldiers living and dead: cheers for the living; tears for the dead. ~ Robert G. Ingersoll

Thank you Uncle Max. You gave your life in World War II far from home crossing a river I lived to see in peacetime even though I never met you.

Thank you Skippy, injured in the jungles of Vietnam. You wore your scars every single day I knew you.

Thank you, all veterans, who gave your lives for the cause of freedom or died later as a result of it, on this Memorial Day.

We remember you and we remember freedom isn't free. You paid the ultimate price.

Happy Boxing Day

Believe it or not, it's a holiday here in the US if you work for the VA. It's not really Boxing Day per se, but W declared it a federal holiday, so most federal workers could get an extra day off. I was at work, but I'll get holiday pay...hooray!

Today was not too terrible. I had the assignment I've had the last three days, so it's been manageable. Get the one guy who gets up up and at 'em right away, so he's happy, then take care of the other two.

For the most part, the other two are very nice, although, the quad is very demanding. He's on the phone constantly, but doesn't want an ECU (no private calls that way). He really needs a Bluetooth with a soft touch button he could use with his one working arm, but that's way beyond what we have at Madison. Sometimes he won't even use the soft touch, much to my chagrin (and it's pretty darned unsafe, too!)

Nevertheless, Oscar and Felix (they really are odd but get along) are doing reasonably well. Felix is in pain a lot, but we medicate him before dressing changes and with his new low-airloss bed with the slick sheet, he can turn a lot easier without him screaming out in pain every time we turn him. He had more pain and problems with his "good" leg today, so hopefully, that is better this weekend. He is a trainwreck in terms of dressings, and he's got grounds for a lawsuit against the place he came from in another state. Thankfully, he is not mean to us (he is upset) but he is thrilled he's at Madison, since we should get him healed up well, barring no other issues.

Oscar has been with us many times. He likes to leave AMA when it suits him. He was here when I started, but left before summer. He's back again, with another suspected caregiver-inflicted wound. It's a doozy and the other hospital tried treating it with a WoundVAC. If only they'd read the instructions about using one with necrotic tissue....arrgh! The docs were aghast when they saw that and away it went as soon as he arrived. We're treating it with the old reliable Santyl moist/dry dressings BID until Dr. Plastic has a look at it after the holidays. Thankfully, it's starting to look better.

'Tis the season for game playing...and I don't just mean with the new games sets that a few families dropped off on the unit yesterday for Christmas, but with the patients, too. We've been having a lot of different varieties.

One is the "Oh, I can't get up to go to therapy" game. This is one of our active rehabbers who's playing this one. He is such a pervert (wiggles his tongue around suggestively when he's getting his intermittent cath) and I really, really wanted to kill him the other night, because he was being such a jerk.

The other game said jerk was playing was "Divide and conquer". Some of our patients try to do this by using the old standby of "no one of this race (color, uniform, you name it) will take care of me right because I'm white/black/Marine/Army/Navy/etc., etc." Said jerk had one of our nurses in tears on my last stretch of evenings. I was really pissed off.

What did he win for that? A smackdown from the neuropsychiatrists. If I would have had one on call, I'd have had them smack him at 2200 while he was up to all his shenaningans, but he had to wait until the next day. They're all off on vacation right now, so they won't harass him until next week. If he were in private rehab, his derriere would be kissing the curb right now since most of them have the "no therapy, no stay" rule. If you decline to go to therapy, you get to leave. Not us, we serve the veterans, and the RPIAs (royal pains in the a*&) really push it sometimes.

Nevertheless, I am happy I survived my holidays at Madison. Now, I'm going to get ready for a holiday party...more to come.

And then there was one...

I started the day with two patients and I ended up with just one, and I'm not even in ICU! Woo hoo!

First, I had to send Mr. R. to a nursing home in a nearby state. It's probably the last time any of us will ever see him. I got his big dressing done and was very careful with it. It was really messy because it was leaking all over the pad he was on when I got to him. Just before that, I had to do a dig stim on him, too, since he didn't get his bowel routine (daily suppository) today. I did this in an attempt to get him cleaned out a little before he left. I cleaned him up, put his theraboots on and a clean gown so he'd be ready to go.

He's not doing well. He was stable, but we don't know how long that will last. He didn't tell us today, but I know he knows he's going home to die. I think it was bittersweet for him and A. was upset that she forgot to say goodbye since she was busy with another patient. I packed all his stuff carefully, put his AM snack in with his lunch and made sure the paramedics knew where everything was. He should see his family today, or so he told me. I hope it all works out for them. We know we did a decent job because he told us he'll miss us. I pray for my patients and he'll be one of the ones on my list. I'll never forget him.

Once I got all Mr. R's paperwork done, Mr. HIJ #1 was my patient for the rest of the day. He was needy as usual, but I got his bath done, his dressing and then I hooked up his IV. He wanted a soda, since none of the volunteers came around today with any, so I went downstairs and bought him one. I even caved in and bought myself one while I was at the machine.

Our boss was gone today, so most of the staff scattered from the nurses' station for most of the day. The slackers, including the Slug, never came near the nurses' station, because you might end up doing some work if you hang out there. I don't care. I'd rather do work than spend my whole day hiding just so I can do nothing. Our charge, P., was busy ordering blood and going with the docs on wound rounds this morning. Thankfully, we don't have tons of people to be inspected, so this went quickly.

I ate my lunch in peace around 1130 before the trays came and I set Mr. HIJ up when his lunch arrived. A the NP and I planned our itinerary for our conference in November. It should be fun. We're on the same flight and we plan on getting some sightseeing done near our hotel before the conference starts. We'll have to start out from here really, really, early, but I think it will work out well.

By the afternoon, I even remembered the other stuff I had forgotten earlier, so Mr. HIJ was happy. He was feeling hot (but afebrile) by the end of the day, so I got him all situated with his fan and everything in his room and he got very comfortable and fell asleep. After that, I finished off as many orders in the computer as possible and then I went on my way home.

Back tomorrow...we'll see how many admissions we really get (supposed to be five!).

Back to work

Oh, I had to wake up this morning to the alarm clock, which I have not done in days!

I got up early so I could make my breakfast and lunch and get ready to take Bubba to school. Dahey leaves before we do, so he was out and off to work in the dark.

I got Bubba to his latchkey program and away to work I went. I checked my e-mails and boy, there were a lot! The most exciting one was the invite to a special out-of-town conference in November. I have to get all my paperwork done tomorrow so I can go. The admin upstairs, L., has been assigned to help me. (You know it's going to be interesting when she tells you that you have to fill out a 12 page form...in order to book your flight.)

I had two patients I haven't had in a long time and I was the med nurse on one hall. It kept me busy. Today, the docs make group rounds to inspect wounds, so this is also interesting. I try to hang out in the room, undo the dressing, then get everyone cleaned up. They got into my room early, but I was really busy with these two guys...and their roommate had me helping him, too. Mr. R. is very needy, which is not unusual for a COPDer. He's always worried about something--his mask, his bowel program, his turns. He looked a bit ashen today, which is very scary in light of the fact that even with his fragile health, he's a full code. I pray we don't have to do CPR on him while I'm working!

I met some new LPNs visiting us with the recruiter. We're looking for them, so we'll see if they come to work for us!

More tomorrow...getting tired and I need to go to bed!

Nuggets for October 18

Here are a few interesting tidbits I've encountered on the internet this week.



While I was working on my post for Wednesday I found an article written by a patient about WoundVAC therapy



Another wound therapy related site of interest: http://www.worldwidewounds.com/



Surgical Materials Testing Laboratory is a UK site which discusses a variety of issues related to wound care and products used to treat wounds.