Friday, October 21, 2011


I have dc'd a couple of nurses, but one has never walked out on me.... until today.  Made my day.
This morning dawned at 03:00 so I could get to the hospital in time to see those doctors who like to wake patients way too early.  I discussed this with Dr. Bograd, and he agreed to put Derek on "sleep hygiene."  That means no one will bother him from 23:00 until 05:00 a.m.  It's only six hours, but it's the best we can get right now.  And we can push the respiratory trach care off until later in the day and not do it at 05:00.  That really is a rude way to wake up.

This morning, however, Dr. Cliffords walked in and announced that we had trouble.  Derek's potassium level, which had been so dangerously low that they were giving him IV and oral supplements every two hours was now so dangerously high that they were concerned about it affecting his heart.  I wanted to discuss this with Dr. Bograd, and he came right in and sat with me.  They wanted to move him to the telemetry ward for monitoring, but telemetry wanted him to go to SICU where they have one-one-one care.

Hi ho, hi ho, it's off to SICU we go!  Third times the charm?  Hopefully we will not have to go back again.  I did love the SICU nurses and care he got while there, but we really hate the sounds of the SICU.  Those beeps and blips are maddening.  And Derek hates all the wires attached to him.

However, the nurse we had when we first arrived was the one from several weeks ago who was so scatter brained I had to keep reminding her to gown up, glove up or mask up every time she walked into the room.  After having been advised of the extreme importance of the monitoring and medication regimen and the need for the SICU vs. the ward or telemetry, I was a bit nervous to have a scatterbrained nurse.

So, I admit, I did not start with the best attitude.  It was made worse when she did not hook up the PCA.  I told her it was not hooked up and she argued with me that she hooked it up.  I looked at the wire on the floor and I knew that when Derek hit the button there was no beep.  I picked it up and asked her what the wire was.  I then connected it.  She rolled her eyes and walked out.

The PCA started beeping "low battery" and I told her it needed to be plugged in.  She said it only neeed batteries, because they did not send her the plugs.  Too tired to argue with her, I plugged in the PCA with the cords that were attached. 

I asked three times for the pain meds that were in addition to the PCA.  I asked three times for the yanker for the sunction machine so that he could suction the flem and not swallow it or spit it into the napkin.  She then went to put the yanker in the sleeve that was already attached to the bed and said, "This looks clean."  I told her it was there for a couple of days, and she threw the yanker on the bed. 

She started humming and huffing and puffing and I said to our OT that we really did not need the vocal chorus, and she turned to me and said, "I think you need a new nurse because I will not be bullied!"  I didn't think asking for the patient's needs was bullying, and neither did the other four people in the room, but whatever.  I had never been fired by a nurse!  Made my day.

She was replaced by a very nice guy, who, I admit, I did jump on at one time, and when he pointed it out to me, I apologized right away.  Extremely stressful day.  Ryan was a sweetie and even covered me with a blanket when I fell asleep in the uncomfortable SICU chair.  I guess I'm forgiven for jumping on him.
After several different meds, some of which upset his stomach, the potassium level did come down, but not low enough to satisfy the docs and get him back to the ward.  So much for Bograd's promise to have us back by noon.  A very unhappy Derek had to spend the night in the SICU. 

The only redeeming point is we have one of our favorite nurses, the crazy Peter, who tried to fire me tonight, but I wouldn't leave.  He said he would keep Derek, but I had to go.  I clung to his arm and gave him the lip, and he hugged me and said I could stay the night if I wanted.  Score!  But since I only got two hours last night, I think I'll rest tonight for a few hours and return tomorrow.

I talked to Dr. B today about when he got on my list.  He actually remembers what he did!  And I am shocked that I didn't write about it but a review shows me that I forgot.  He was changing Derek's central line and went to stitch it in place without numbing the area.  Okay, so there is some debate about whether the lidocaine hurts more than the stitching, but give the patient the option!  I do love Ben and he has more than redeemed himself.  I do not hold grudges as long as my kids are okay. 

I don't know if the ortho department will ever get off the list, though.  They are pretty ingrained there.
Hopefully Derek will be out of the SICU tomorrow after the dressing change in the PACU tomorrow.  He has asked both Dr. Howard and Dr. Bograd to let him stay awake during the procedure, and they agreed to let him try it with local anesthetic if needed, and sedation only if necessary.  He really hates any type of anesthetic or sedation.  The procedure is for the dressing change on the flap, along with placement of an elastic to begin the take down of the flap, and the wound vac and dressing change on the one wound that reopened.  Hopefully he will be able to tolerate it.

So, day 83 comes to a close, but who's counting?  Good night and God bless.

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