Sunday, October 2, 2011

Communication 101

Family visiting and helping raise Derek's spirits is the best thing for him.  Today, my father left after spending four days with us.  Krystina's Dad, Grandma and Grandpa thereafter arrived for the weekend.  That is a few too many people for the small room, and Derek was a little overwhelmed, but family understands.  There is a waiting room down the hall, and since the important thing is visiting Derek, they stayed in the waiting room and came and went as he was able to visit.  They stayed all day, visiting at short intervals, and will be back tomorrow.  They love Derek and just wanted to spend time with him when he was able.

Derek's spirits were definitely raised by the visit.  He told them he will be a walking maching and would be running by next year!  We don't doubt it.

Today was a little rough medically, but the spirits were soaring high.

Blood pressure issues plague Derek.  In the OR, the BP runs too low.  During the IR procedure, they uses versed, fentynal and propofol.  They use similar agents in the OR, and they seem to work; however, for the type of surgery he gets, he also needs muscle relaxers and paralyzing agents.  They reduce the BP.  Albumen (sp?) worked to raise the BP on Friday.  They are hoping this works enough to raise it on Friday.
But whatever the issue, the BP is a little too high right now and he is retaining fluid.  That is not good for this repiratory status.  Lasik was ordered tonight to reduce the fluid.  We will see what the morning brings.
The nurses were concerned with the color of Derek's urine and called the on call day doc who ordered a culture.  Thankfully, Dr. Bograd showed up at just the right moment.  He knew the cause just by looking at it - the placement of supra pubic yesterday.

And Dr. B tried to guess how to pronounce my name.  Turned red at my teasing.  I let him off the hook and explained the Irish phonetics to him.  He is such a cutie.  He has three year old twins and showed me pictures!  I love this doc, but he might be on my list after something that happened tonight.  I will wait until he explains himself tomorrow.....

The night nurse told me they were holding the Tylenol to see if Derek ran a fever....  wait....  Tylenol?  Didn't I DC that through the docs a few weeks ago?  I had to go through several docs to get that DC's when the pain team put that on the list without discussing it with me.  Took a couple of days, but I finally got it agreed to that we would wait until all antibiotics were finished before starting to worry about weaning off narcotics by using Tylenol for pain.  And he is on Tylenol now, for what?  And more importantly, why wasn't I consulted?  I was told the pain team ordered it and Dr. B signed off on it.  We will discuss this tomorrow.

One of the highlights of my day was a conversation with a couple of nurses after yet another incident with an RT.  The Respiratory Department is seriously going to dislike me.  Oh well.  Do your job and you will not have to worry about me.  The nurse wrote one up tonight and I will follow up on Monday.

Derek needed to be deep suctioned.  This is where the catheter is placed down inside the lungs through the trach or nose.  The nurse, corpsman or the RT wears sterile gloves if it is going into the trach because it is a sterile procedure.  The nose is not a sterile procedure because we have filter in our nose.  There are no filters in our throat.  This is how it was explained to me in SICU.  The one nurse tonight said there is some debate about it.  When I explained that to her, and said that made complete sense.

The RT tonight told me the air is not sterile, so this is not a sterile procedure and he did not have to wear the sterile gloves but would if I wanted him to wear them.  I told him it was a sterile procedure because there were no filters in the throat and he was going into my son's lungs.

Derek was protected tonight but what about his next patient?

The problem is the Feres Doctrine.  Active military cannot sue a military hospital for malpractice.  This is nonsence.  These doctors and techs have full immunity from every type of gross negligence no matter what they do.  They don't have to be careful.  They don't have to care.

I've found that most of them do.  But there are some that just don't.  Hypervigilance.

But the nursing staff is awesome.  And the main doctors are wonderful.  It's the ancillary staff.  I'm getting fed up.  I'm raising hell.  The nurses tell me I'm the best advocate for me son and I need to keep making noise.  I do not need any further encouragement.  Now where did I put that bull horn?  To heck with that.... I can be heard without it!

Have a great night!

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