This List is REAL

Our lives have been in a state of turmoil lately.

Sadly, life does not seem to slow down when turmoil comes, but in some ways it seems to go into super fast forward and you just want to say, "WAIT!  Slow down!  I didn't have time to check homework or fold laundry, and I'm tired and all I want to do is sleep, but I can't sleep, and then the night drags on and on and on..."  And then the next day I'm tired and the day is flying by and I'm not managing time wisely because my brain is circling around and around topics that I have no control over, but can't seem to make myself stop worrying about.

Guess what?  In the midst of this turmoil my Grandma Irene is coming to my house for the VERY FIRST TIME EVER.   I'm super excited.  She will be here Tuesday evening.  I will work tomorrow.  I will work Tuesday.  I will be on call both of those days, unless I can find someone to switch with  me Tuesday.

So all of that whining is to say this:  After taking a two hour nap today (which I really did NOT have time for) I made a list of things that MUST be done before we all leave for work Tuesday morning.  I think the list is rather revolutionary if I do say so myself.   As I was writing this list, in the exact words I'm about to share with you, I said to myself:  Instead of packing the last of the red dishes on the hutch, I do believe I will blog this list. 

(Because my decision making processes are always full of wisdom and ambition.)

And so I am. 



Chores to be done before GRANDMA IRENE arrives on Tuesday afternoon:

Girls:
-Dust (Your bedrooms too!)
-Clean your bathroom
-Vacuum your rooms

Brent & Andrea:
-vacuum remainder of house
-hutch
-Hide Clutter in Closet if All Else Fails
-Our bathroom
-Oh no-We have basketball practice for Bookworm Monday night!

You see, I glanced at our hutch and number three simply flowed out of my brain and onto the paper.

I'm pretty sure it is imperative that it remain.

Now to figure out what to make for dinner for my Grandma Irene's first ever visit to my house...

I have some leftover chicken.  I'm nearly out of dog food, so I must stop at the store tomorrow on my way home from work.  I'm thinking I'll grab some refrigerated pie crust and make some pot pies tomorrow night for Brent to pop in the oven around 5pm or so Tuesday night...

It's either that or carry out pizza.

Enunciation (Or How An Accent Changes Things)

Attention:  This post contains language that I don't use...Except that I'm having to tell a story.

And the story just isn't the same without direct quotes.

And they use the word in the Bible.

So surely that makes it okay.

Yesterday's post about Rasslin' made me think about accents.

And that made me think of my dear friend Jennifer.  She's from Tyler, Texas and her accent is quite catching.

So catching that when we lived in Texas Grace said such words as "hotayel" instead of "hotel."  Since I didn't tend to add extra accents to my vowels, I could only blame such things on Jennifer...

Anyhoo.  We lived in Arlington, TX for eight years.  And for six of those eight years, I worked at a hospital in Fort Worth.  Two years as a nursing student, and the last four as an RN.

One day Melody (one of my fellow RNs) and I were standing in the medication room, drawing up medications in syringes and doing all sorts of other "nursey" type things.  Things that require the UTMOST attention to detail, so I'm QUITE certain that there was just NO way we were discussing our precious new baby girls who were mere weeks apart...

I'm sure we were discussing cardiac rhythms and fluid overload and uncontrolled diabetes...Or some other lofty, most excellent and invigorating subject.

But the POINT is that we were in the medication room.

And we were possibly chatting.

And then a respiratory therapist stuck her head around the corner (this was before the days when medication rooms became required to have locked doors) and said, "Hey guys, where do y'all keep your ass?"

Melody and I froze.  We slowly turned and looked at her.  Two heads turning, eyes widening...

"Excuse me?"

"Where do y'all keep your ass?"

There was a beat of silence.


"Our whaaaat?"  And we both began to slowly turn our heads to look over our shoulders at our, well...Our backside...


"Your ass!  Your ass!!  Where do you keep your ASS?"


And suddenly Melody, who was Texas born and bred said, "Oh my gosh!  Ice!  You are looking for our ice!"


And we both broke into peals of laughter.


I'm not sure if we answered her between gasps of hilarity, and gestures to our behinds, and broken phrases of "Oh my gosh" and "I thought she was saying ass" and "me too!"


And then we laughed some more.


As the day progressed we'd be working along, bustling this way and that up and down the halls, in and out of rooms.  We'd happen to enter a door at the same time, and then our eyes would meet and one of us would say "ice" and the laughter would start all over again.


We dined on that request for ice for months to follow.


Strangely, the respiratory therapist never seemed to find the humor in the situation.

Rasslin'

Okay, just to be clear for those who don't know me: I truly do say "wrestling." I even put the "ing" on it, which is a pretty big deal here in Oklahoma.  Makes me seem all proper like and ever'thin'...

Tonight I took the girls to a fine Mexican establishment for dinner.  Studmuffin was eating Buffalo Wild Wings with a friend, and rather than use the practical "save money" route, I went with the "Dad gummit if he's eating out, I am too" route.  I really like that route.  As I was having a brief accidental conversation with my sister (the kind where you don't mean to call her, but then the call doesn't go through so it's okay, but then she gets all mannerly like and calls you back anyway) and I over heard the following conversation between my two girls.  I made them repeat the entire thing, just for accuracy sake. 

Because I immediately recognized it as a very blogworthy moment, and those are few lately.

And I'm thorough that way.

Bookworm was telling Popcorn about a wrestling match.  You see, Bookworm is our local expert on many, many things, and she was the most informed of all things wrestling at our little table of three.  Because A) She reads voraciously, and B) She actually saw a real live wrestling match, which all sixth graders were required to attend to support their school...

Popcorn:  Do you think I could take down an eighth grader?

Bookworm:  I don't think so.  They're really tall.

Popcorn:  Well that's when you bite'em!

Bookworm:  There is no biting in wrestling.

Popcorn:  Then I'll pinch them!  (Sadly, she took down a cousin that has a good thirty pounds on her by this very technique.  Not all of my parenting moments are proud ones.)

Bookworm:  There's no pinching in wrestling either!

Popcorn:  Oh.  Well then I'll just punch him in the FACE!

Bookworm:  There's no punching in wrestling.

Popcorn:  WHAT KIND OF WRESTLING IS THAT!!!???

Me:  That's called wrestling with rules.

Popcorn:  Wrestling with rules is unnatural.

????

Being the dignified parent that I am, I burst out laughing.  Very loudly.

I don't understand the point of quiet laughter.  It's just no fun.

Unless you're laughing so hard that you go all silent laughter, and you can't inhale because you're laughing so hard, and then if you're in my family you suck in a giant breath of air...

And then you sigh a long drawn out sort of high pitched sigh like about an "A" above middle "C"...

And then if you're all together as a family, the gasp and sigh somehow synchronize so that starts an entirely new round of silent laughter that makes my dad's face get alarmingly red, and you almost fear he will have a stroke, but nonetheless you can't stop laughing long enough to make him stop laughing...

What has made you laugh lately?

Proverbs 17:22 A cheerful heart is good medicine, but a crushed spirit dries up the bones.

P.S.  I really should avoid this particular establishment as it was the sight for the great choking debacle of 2010.

Really, you should totally click that link for a refresher laugh, even if you've already read it.

Putting A Face To It

Today I received an order from one of our kidney doctors to remove a dialysis catheter from one of his patients.  "I don't know why Southwest left this line in when they discharged him a few days ago.  It needs to come out."  The line is one we consider temporary, and not safe to be left in outside of the hospital as it is only held in by a stitch, and if it comes out the patient could bleed to death if proper pressure is not applied.

Just another day in the world of health care...

 I had the patient come to our department after his dialysis treatment.  I noted that he was Mexican.  I asked if he spoke English and he said "Yes."  I asked what his plans were for dialysis if I removed his access.  He simply shrugged.  After a brief interview I realized that he was not sure if he still needed dialysis, and if he did, he was not sure how he was going to receive it. 

"Are you supposed to go home today?"

He said yes he was, but still didn't have an answer how he was supposed to get treatment.  I pulled up his chart on the computer and looked up the note from his doctor.

I was startled at what I found, but I could understand the reasoning behind it...

I had just never found myself in the position of explaining such things to a patient.  After a moment's thought, I read the following doctor's note aloud to the patient:

Patient is an undocumented worker from Mexico.  I instructed patient that he needs to return to Mexico where he can get health care, and continue treatment for his renal failure.  I also told patient that if he develops shortness of breath, he needs to return to the nearest hospital where he will be treated for his renal failure.

The patient became very reserved and stoic after I read the note aloud to him.  I asked if he understood what the doctor was saying.

He shrugged and avoided eye contact with me.  I wondered what he was thinking.  I wondered what he thought I was thinking.  Did he think I felt he didn't deserve health care because he does not have the proper paper work?  My reality is that even if he didn't have paper work, as a laborer, odds are he wouldn't have insurance.  Of course, our state Medicaid system would step in if he were a legal citizen.  Instead, this man has a serious, terminal if not treated illness, and no means to get it paid for. I quietly stood beside him and thought about his situation and the consequences.  I wondered if he was able to fully grasp what was going to happen with him, considering his not quite fluent English.  How do I explain what he is facing?  What do I say to a man that I know is doomed to death if he does not receive treatment?

Sometimes there are just no words to say.




After what felt like an eternity of silence, I asked him if he understood what it meant to lose function of his kidneys.  Again, he shrugged.

"Juan, once you've lost function of your kidneys, it usually means that it's permanent.  They are no longer able to clean out your blood of toxins and fluid.  Those toxins and fluids build up and you end up back in the hospital, unable to breathe.  The best thing you can do at this point is dialysis, which is what we've been doing.  Unfortunately, you don't have insurance, and you can't get insurance because you're not a legal citizen.  That is why Dr. K is suggesting you return to Mexico."

Of course he continued to look straight ahead, and barely acknowledge what I was saying.

"Has anyone talked to you about monitoring how much you drink and changes in what you eat?"  He didn't remember if they did.

I don't doubt that he has been instructed on both of those things.  I just don't think he really understood what he needed to do.  I tried to explain the importance of watching his fluid intake.  I talked about avoiding the salt shaker.  At first I thought he was not going to engage in the conversation.  He surprised me by asking how much he could safely drink in a day.  I told him that it varies from patient to patient, and he needed to ask Dr. K.  "However, a pretty basic measure is not over two liters."

Of course he had no clear idea of liters.  I told him to think of a big bottle of pop, and I got a foam cup and told him to not drink over nine of  those a day.  We discussed that he has to consider liquid from soups, jello, ice cream and even ice.  I gave the lecture on no soda and certainly  no alcohol.  He told me he doesn't drink "cerveza" and I told him I hoped that was so.

I removed his dialysis catheter with a heavy heart.  My mind was spinning with things he needed to know to have any hope of controlling this disease without dialysis.  And yet, I realize that all of those things are really just tiny bandages on a huge gaping wound.  After I removed his catheter I reminded him to leave the dressing on for at least one day.  I reminded him to ask about foods he should avoid, and what level he should keep his fluid intake at.  When I called report, his nurse was off the floor.  I asked the nurse taking report for him to please have her get a dietary consult so the patient can have a better idea of what foods would be safe to eat.

After leaving Juan's bedside, I went to my next patient.  Also of Mexican decent.  She speaks little to no English, and instead of removing, I was assisting in PLACING a permanent dialysis catheter.  She will go home and receive dialysis three times a week, four hours each day...And it will all be paid for by the tax payers because she is on the state Medicaid program.  You see, she is here legally.

Juan is not.

Same disease.  Same background.  Taxpayers will be picking up the tab for both patients.

I can't get  his face out of my mind.  He was a quiet man with unexpected green eyes.  He was slim and well groomed.  After digging through his chart as we chatted I discovered his kidney disease was probably caused by high blood pressure, which he had not realized he had until it was too late.  He still did not understand his high blood pressure when I talked to him.

When I'm outside the walls of the hospital it is easy to say that we have to stop giving health care to all of these illegals.  It's easy to complain about the drain on our budget that their children are, because they all get coverage.  However, when you are looking in the face of that person, and you know that they will surely die without proper care it is a big pill to swallow.

Of course, I realize Juan is still getting health care.  And, he's getting it for "free" as there is probably no way he will be able to pay, and no way for us to collect. 

I was physically ill as I spoke to him.  His condition will only get worse.  He will continue to go into a crisis of fluid overload.  This will cause him to either go to the hospital where he can get a temporary dialysis catheter placed like the one I removed today and receive a few treatments until he's "stable" and the doctor can discharge him and try not to let him weigh on too heavily on his already overburdened conscience.  (After all, any doctor that works for our hospital is not in it for the money.  We are known for giving away free health care.)  Or, Juan will literally drown in his own body fluid because his heart will be overloaded with fluid and literally give out from inability to deal with the fluid.  If by some miracle he is able to manage his fluid intake without dialysis, his kidneys will not be able to manage the waste products and his potassium levels will become so critically high that he will die from cardiac arrest...

So that sucks.

He will continue to be a drain on the system, getting "free health care" because no hospital will turn him away.  This is not near to the cost if he actually received dialysis three times a week, four hours at a time like he probably needs.  But it will still be a cost to the taxpayer. This sporadic treatment given as a result of recurring crisis will take it's toll on his body, and his kidney disease will progress rapidly.

And then he will die. 

So that sucks even more.

As I spoke to Juan today I realized that putting a face to something changes your perspective.  I'm not saying that illegals should all get free health care.  That would just be crazy.  What I will say is that it's a lot easier to say "kick 'em out of the country" when you're talking about a nameless, faceless person.  What will happen to him if he returns to Mexico?  Will he get treatment?  I can't imagine that he will get the level he would here.  I imagine he would be treated from one crisis situation to the next.

But maybe I'm wrong.

All I know is that he is a man.  A human being with a family and friends and hopes and dreams of a better life.  He is a creation of God.  He has a scary diagnosis that I don't think he understands.  I pray for his safety.

Cockroach Killers

Have you ever seen those really pointy toed cowboy boots?  I realize they have actually made it to the somewhat "fashionable" world of western wear.  However, when we lived in the Dallas/Fort Worth area, they were NOT in style.  Anytime we saw someone wearing them Brent would say, "Look at those Cockroach Killers."  Apparently the pointy toe is really good for getting into corners.

Today at work I noticed a bad smell in our department.  Our bathrooms have drains in the floors.  They were designed for showers.  However, nobody actually showers in our bathrooms, so gases build up in the drain pipes and they start to smell.  Our friendly environmental services repairman taught us to pour water into the trap every so often to alleviate the smell.  It works like a charm!

So today I noticed the smell.  I dumped some water down the trap, and the smell remained.  So I dumped some more.  I was on my fourth cup (I was using a large foam cup) and wondering how many cups it would take.  Suddenly a cockroach no less than two inches long climbed out of the drain.  It took all of my willpower, but I held the scream inside my throat (so as to not alert patients to the fact that critters were invading) and jumped up and stomped on it.  However, as I was turning to stomp the quick little critter, three more came darting out...

I stomp, stomp, stomped gave a great big shuddering "Uh-uh-uh-uh-uh" (insert zombie-ish moaning sound) and scratched my body all over, then convulsed some more as I put on a glove, grabbed a paper towel and disposed of the still antenna waving horrors...

Aside:

I had only seen roaches one other time at our hospital, and those actually climbed out of one of a patient's bag and up my arm...And believe it or not, I stifled that scream to, in an effort to not offend the dear lady.  I calmly handed her bag to her as I tried to subtly stomp the roaches that I'd just flicked off of my arm.  She calmly dug a banana out of her bag and began to eat it... Completely oblivious (desensitized) to the roaches that were swarming inside it.

*Shudder*

After she left I killed three more roaches in that bay and nearly had a heeby jeeby breakdown.

Back to present day:

I tried to nonchalantly leave the bathroom to call environmental services.  I decided not to call at the nurses station as we had patients in the department.  I went to an office, and one of the PAs was on the phone.  I went to the front desk, and there was family in the waiting area.  My supervisor wasn't in yet, so her door was locked and I felt weird about waltzing into our doctor's office to use his phone without him there...

I wandered back to the holding area just in time to see one of our female patients come scurrying out of the bathroom and say, "There are BUGS chasing me in there."

Color me mortified!  I said, "I'm so sorry," and walked in to the bathroom to find four more roaches running around the floor.  I stomped, stomped, stomped, stomped, slammed the door shut, leaving the light on, and tucked a blanket under the door.

Now, I realize the blanket wasn't going to stop them, but I was hoping they would want to prefer the dark, and therefore not come out of the drain since I was leaving a light on...

I then gave up all pretenses of subtlety and called environmental services who helpfully informed me pest control was coming that very day, but they were going to ER first...Of course the pest guy had other errands to jobs first.  I don't understand how any pest problem could be a bigger deal than ours.  But there ya go...

Later on I went to chat with the lady and apologize AGAIN and express my mortification over the roaches.  "I have NEVER even seen a roach here.  I am so sorry for your experience."  (Okay, so I fudged a little, but the other roaches were carried in and mostly out by the same patient.)  She laughed and told her family how I saved her from attacking bugs.  We were all laughing about her hysteria when her sister said, "I love your shoes!"

"Thanks!  They make great roach killers!"

And you guys thought they were a purely frivolous purchase!

Rugged

A few weeks ago, the following conversation ensued in our car.  I believe it was on the way home from one of the girls' Christmas concerts.

Me:  Hey girls!  I finally bought that Michael Buble' Christmas cd.

Girls:  Yeah!  Put it in now.

Brent:  I finally saw a Michael Buble' video.  It made me mad.


????

Me:  Why?

Brent:  He can sing and he's good looking.  And he can dance.

This statement was met with much hilarity and laughter from the female gender in the car.

Me:  Honey, you don't have anything to worry about.  Michael Buble' is good looking in a pretty boy sort of way.  You are ruggedly handsome.  I prefer rugged manliness.

Popcorn:  That's right Dad!  Who cares about clean when you can have rugged?
 

Stress Eating

When a crisis arrives and I'm at home the immediate reaction is to clean the entire house from top to bottom.

When a potential crisis arrives at work, my immediate reaction is to wish I had some fountain Dr. Pepper and Nacho Cheese Doritos.

Yesterday at about 3:30 my supervisor said, "Is Dr. G going to do that ICU patient tonight?"

"What ICU patient?  He didn't mention it to me."

"It's that patient that coded this morning.  He wants to do her tonight, and he needs anesthesia, but they can't come until after 6."

Well, great.  I immediately began needing some Doritos and DP.  After all, if she coded odds are she's pretty sick.  And I hate dealing with really sick people late in the evening.  The rest of the crew has left, and that leaves the call nurse, the doctor and two radiology techs... unless you drag the ICU nurse into the procedure with you...

I went out to ask the doctor if we "had" to do the case that night, or could we wait and do it the next day and we'd book anesthesia...And of course, that would mean our entire department would be there in case things started going south...

He called the attending doctor who responded, "I think her gallbladder is obstructed.  If that is the cause of her sepsis, then she won't make it through the night."

Well, crap.  I called the anesthesiologist who was immediately annoyed that we were wanting him to put a patient under for a procedure when her labs were terrible, she's on the ventilator, and her blood pressure is still sketchy even though she was on the maximum dose of pressor meds.  (Pressor meds are given when a person's blood pressure is too low.)

 Oh, I just feel compelled to tell you in an aside note that one time I tried to refuse to do sedation on a very sick patient with Dr. G, because I was almost certain they were going to die on the table.  I wanted them to stabilize the patient more before we did the procedure.  He looked at me and said, "Andrea, this patient is going to die very soon if we don't do this.  So, he can either die with us trying to save him, or we can do nothing and he will still die."  What do you say to that?  We did the case, and the patient lived.  But I swear I carried knots in my neck and shoulders from the stress of that case for weeks afterwards....

After speaking with the anesthesiologist, I reported back to Dr. G that the anesthesiologist said I couldn't bring the patient to our department until he had seen her himself in the ICU.  And I was very okay with that...

However, my dad gum doctor just said, "That's okay.  I'm on my way to the ICU right now.  I think we are just going to drain her gallbladder, so I will just need sedation, and you can do that.  Come with me."

I could?  I didn't WANNA do sedation on this lady!  Grrrrrr...I grabbed my DP and chips and headed out the door with him...

(Thankfully, one of the radiology techs that was NOT on call had ran down to the cafeteria and bought me a fountain Dr. Pepper and Cool Ranch Doritos as they were out of Nacho Cheese...She knows me well.)

He and I took off down the hall, sharing my bag of Doritos...Yet, he pointed out that he thinks it's tacky to eat and walk at the same time.  I told him to "Shut up and eat a chip."  And he did.  He knows when he's living dangerously.  (By the way, we tell each other to shut up on a regular basis.  In fact, I pointed out that I've told him to shut up more than any other human in my life.  He said it's ditto for him, unless we count his sister and that took an entire LIFETIME to reach the quantity of shut ups that he's given me.  We aren't sure if this is a good thing or not.)

He walked into her room, where three family members were at bedside.  He immediately started telling them what we were about to do.  As he was talking, I noticed that she was on continuous hemodialysis...This means her kidney function was so poor that they had a machine hooked up pulling her blood out and cleaning it continuously.  I then noticed that her blood pressure was 66/47.

YIKES!!!

I immediately went to find the ICU nurse and tell her that if I had to take this patient and sedate her, then she was darn well coming with me.  And to shove a few more Doritos in my mouth and suck down some more liquid Xanax...Well, fortunately, the nurse had already talked to the attending and convinced her that the patient would probably not survive the transfer to our department and subsequent sedation.  She told Dr. G this, and asked if there was any way possible he could put the drain in at bedside.

"Sure.  We can try that."

How do you spell relief?

Well, we put the drain in at bedside, and the poor woman hurt tremendously as we did it, because her blood pressure was too low to give her anything to ease the pain.  The doctor kept asking us to give her something for pain, but the ICU nurse was adding a new pressor med, and another ICU nurse had joined us for moral support, (and to hold her down because it really did hurt,) and we were all presenting a united "refusal to give pain medicine" front...So, it hurt her really really badly.  But she lived through the procedure.

Dr. G said this is the first time he's drained a gallbladdder without giving some serious meds to get through it.  The three of us just put on our callus nurse faces and said, "Well, now you can check that off your list."  And we all thanked each other for the good work, and I went home, slurping on my drink and wishing I hadn't shared the last of my chips with the doctor...

So, what do you want to eat when you are stressed?  Do you eat at all?  Do you go into a frenzy of activity?  Perhaps you curl into the fetal position and stare at the ceiling fan...