Saturday, October 1, 2011

Lost Marbles

Has anyone turned any marbles in to the Lost and Found, because mine are missing......
I had heard this was a roller coaster, but in the past, we had a couple of calm days.  This has been eight days of stress and battles for me.  Instead of a roller coaster, right now I feel like I am on Free Fall.  But the good news is, Derek is improving.  That's the goal.  I can handle the stress and battles as long as he continues to improve.  I've been at the helm of the ship for years on my own, I think I can do it for a while more.

I escorted Derek to PACU at 05:45 this morning and noticed that his tube feeds had been stopped.  Why?  Shortly after I left last night, the night doc noticed something in the notes that when IR places a new tube it cannot be used for 24 hours so his feeds were stopped.  But IR had said that the tube was good to go, so why did he stop it?  I was ready to kill because Dr. Goodlett (ward intern) said they were to start as soon as he got back.  He went all night without nutrition.  I hope that night doc goes 24 hours without food because he was wrong.  Dr. Bograd (trauma resident) took care of it, but I already pitched a fit.  If I had stayed last night and not gone back to rest, it would have been taken care of last night.  I told Dr. West I just wanted the IV drip of caffeine set up.  He said that wouldn't work.  I'm willing to try.  I'm not picking up Dr. West's breadcrumbs...  yet.

Surgery was a washout of the arm, replacement of wound vacs and replacement of the supra pubic catheter. 

Unfortunately, the supra pubic was not placed properly.  Derek woke in the PACU in pain and needing to pee.  Krystina and I walked in to chaos.  Bograd was there trying to help him and paging urology to fix it.  They got a bin and wanted him to go on his own.  He said to me, "Mom!  I think I'm peeing!  Can you look?"  Just what I wanted to hear from my almost 22 year old son.  He's not shy.  They got it replaced and then we proceeded back to the floor.  The urologist looked at me and said, "At least you know he can do it."  Thanks for that.

Had a little fun with Dr. Bograd after that.  I am trying to make him pronounce my name.  He is dodging me.  I am sure he has asked someone how to pronounce it and will come back next time with the right pronunciation even though he said he would figure it out on his own.  He told me he was afraid to try because he is in my good graces and doesn't want to mess it up.  I forgive him his one little indiscretion from weeks ago because he has given Derek awesome care since then.  Mispronouncing my name is not going to matter to me, and I told him that.  I called him a chicken, and let him go.  Twice.  He said he'll be back with the pronunciation.  We'll see.

Best news from surgery was that albumin (sp?) raised his blood pressure, so that might allow them to do the free flap on Monday.  Dr. Howard came in and discussed it.  His concern is a five to eight hour surgery getting albumin might affect his pnuemonia and all of the fluid we just drained from him this week.  He walked in convinced we were doing the pedagal (sp?) flap but walked out hoping anew to go with the free flap with the other as back up.

After talking to a number of people about both procedures, and after having extensive conversations with Dr. Howard and Dr. Perdue, whichever they decide in there, I will trust Dr. Howard to make the right decision.

Dr. Ron Goodlett is on leave this weekend to attend a wedding.  He came by today with his adorable little daughter.  She is six months old and absolutely precious.  He asked about Derek and addressed my concerns, even though I was not discussing them with him.  He is an intern doing his rotation on 4 center right now.  Can I keep him?  He was on the SICU before and is my familiar face on the ward.  I felt more comfortable here knowing him but now I love him.  His bedside manner is top notch.  Some of the more experienced docs could learn from him!

Master Sgt Bell came to visit this evening and told Derek that he could tell all of his buddies that a Master Sgt wiped the sweat off of his brow!  She is a joy!  We will be so sorry to lose her at the end of October when she retires!

Tonight Derek's potassium is dangerously low so they did an EKG which was not reliable and are running a continuous drip and giving him nasty tasting meds.  Due to the new J/G tube that was placed, they cannot give him meds in it because it is too small, so he is swallowing pills and has to swallow the nasty tasting potassium every two hours until the blood level is checked again.

I had a crisis of confidence before I left.  I addressed it with the charge nurse, the awesome Janea, and then I felt better.  Derek said he wanted to be suctioned.  His nurse tonight, who has never had him before and didn't know the history, asked the corpsman if he had ever suctioned before.  He hadn't.  She left the room.  Fifteen minutes later, when she had not returned, I started making noise.  Derek didn't say he wanted to be suctioned immediately, so I waited a few minutes.  The corpsman got another corpsman, and then they couldn't find any catheters.  It took a few minutes to find the catheters and for the second corpsman to get the suctioning finished.  Had he been in respiratory distress, it could have been disastrous.

What happened?  She wanted the corpsman to learn how to suction so she went to find the respiratory tech who had just left to teach him.  Sorry.  Derek has been in so much respiratory distress this past week that I would never have allowed someone who has never suctioned before to deep suction him.  How about asking me if it is okay? 

I know this is a teaching hospital.  I know that everyone has to learn.  But patient care and safety is first and foremost.  When you have a patient who has been in severe respiratory distress, you do not put them in harm's way by having a beginner suction them.  And you ask permission.  Whenever I've been with student's before, they have always asked my permission before doing anything on me.

Crisis of confidence.  But for the fact that the nurse who stood by his bedside last Saturday night is charge nurse tonight, I would be sitting there right now.

If God brings you to it, He will bring you through it.  He must think Derek is pretty strong, because He has certainly brought him to and through a lot, and there is a lot left to go.

There is a contest to award an engagement ring to a deserving couple, and someone nominated Derek and Krystina!  The facts were a little skewed, but the contest owners allowed me to add a paragraph.  Please vote for them.  It would be wonderful to give these kids something special.  Derek has been trying to save for a ring for Krystina, but we all know the Army does not pay a lot!  They are entry 104! 
Even if they don't win, they have the best prize of all - each other.

I need to go find my marbles now.  They are rolling around here somewhere.

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