Saturday, October 22, 2011


I love how some doctors think it is okay to enter orders without having ever laid eyes on the patient. Three times today doctors entered orders without seeing Derek. Two of those doctors I did not know. One was the little intern I threw out of CT scan for being an idiot. He told me to take off the dressing on the arm and tape it in place. Ummm, no. Dr. Howard laughed when I told him. Dr. Bograd said I had good intincts to tell him no.

This morning, Dr. Mickeymouseawich (his name is something like that and I cannot remember it) decided to change one of Derek's IV meds for gut mobility to have it go through the J-tube.  The orders specifically say that nothing is to go through the J-tube except water and the tube feeds, because it makes Derek sick, with the exception of specific meds ordered by his primary team.  Dr. Mickeymouseawich is NOT part of his primary team.  He had NOT come to see him.  He took the recommendation of the pharmacist, who had also never seen Derek. 

I saw the nurse start to give the meds and stopped him.  I asked him to hold off until one of Derek's primary doctors came and spoke to me.  I am still waiting.  Finally, at 22:00 tonight, another doctor who had never seen Derek, responded to the nurse's request to reinstate the IV meds for gut mobility.  I do not have a problem with that because he was simply reinstating a previous order at the nurse's request, which was at my request.  If the primary team comes and tells me that it is a good move, then I will go with it.  My problem is doing it without seeing the patient and without knowing the effect it might have on him.  Meds through the J-tube make him sick.  They had to give him something for the potassium problem through the J-tube and he got sick from it.

The other doctor I am not happy with it the one who increased the water flush of the J-tube.  Why?  What is the reason?  This J-tube is very finicky and has already failed once.  Does this doctor know this?  Has this doctor seen this tube?  Does this doctor know that this is not a regular sized J-tube and cannot handle a regular sized flush?  Does he know Derek's history?  Why the increase?  I asked the nurse to find out the whys before doing anything, and she said she would hold off until the morning when the primary team could review it.  The last thing we need is the J-tube to fail because it it blown by an overzealous doctor.

Why can't doctors simply examine patients before they enter orders for patients they do not know?  You would think that would be the right thing.

But the good news is that Derek no longer has banana blood!  The potassium levels are normal and we are back on the ward. 

We were supposed to be first case in PACU for the dressing changes this morning, but they never called for us, so Dr. Bograd came to us in SICU.  He offered to do the dressing change there, and Derek asked to remain awake, since he hates anesthesia.  They gave him a little versed and dilauted, and he handled it.  I wasn't kicked out, like I would have been in PACU, and Dr. B said he doesn't mind me being present because I am never in the way (ha!).  I helped by handing them supplies and silencing alarms, and I do have a stronger stomach then I thought.  The wounds are deeper than I thought they were, but they look pretty good.

Dr. B and I discussed what he did to get on my list in the beginning.   He actually remembered!  I didn't have to remind him.  He is a great doctor, although I still think he should have given the option before jumping in there to stitch without the lidocaine back then and I told him so this morning, and I am upset he didn't come talk to me like he said he would this afternoon, but I will await his explanation tomorrow before putting him back on my list.

The nurse came in and told me the minions had arrived for the dressing change on the flap, but Dr. Howard was not there.  The man himself showed up shortly thereafter.  He allowed me to stay, as well, and the flap looked great!  Derek watched Dr. Howard manipulate his arm and even asked if he could remain awake in the OR on Tuesday when they take down the flap!  The crazy doc said he might consider local anesthetic! 
Dr. Howard also told me he would have allowed me to stay in PACU for the last dressing change but then this bitch got nasty with me to leave.  I was glad he noticed that and it wasn't just me.  Krystina and I were standing off to the side talking to Dr. Bograd, about two beds away from Derek when Dr. Howard wanted to start the dressing change.  The anesthesiologist said in a nasty tone, "I am waiting for the family to leave!"  I replied, "I am talking to the doctor and not near you!"  I then turned my back and continued my conversation.  Bograd rolled his eyes and we didn't move.  She shut the curtain loudly and they began.  Bograd laughed and we finished our conversation.

Sorry.  I am not here to make friends.  My life at home is not falling apart so I can make new friends.

But the world didn't end today!  So much for Harold Camping.

Derek did get his hair washed!  First time in three months!  We love you, Sam!  Thank you!  She got drenched getting into the shower in her scrubs to help out, but he was in heaven!  It's the simple things we take for granted every day that these guys miss.  Simple things like taking a shower, washing your hair, brushing your teeth, or even feeding yourself is a chore.  Derek cannot feed himself right now and must rely on others for everything.

And there were more medevacs tonight.  Every siren sliced through me like a knife.  It brought back the memories from twelve weeks ago tonight when the bus rolled up with Derek on board.  I will never forget the fear, heartbreak, and simple relief when I finally got my eyes and hands on him.  My heart was breaking for the families of the warriors being admitted tonight as I sat there listening to the sirens as they got closer.  Three times a week they arrive.  When will it end?  I am tired of hearing the stories of Tom, Todd, Paul, etc.  I do not want any more young lives altered forever by these injuries.  It needs to end.

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