Wednesday, October 5, 2011

"My Cat Is Deader Than A Toenail"

It was once said to me, if I didn't have bad luck, I'd have no luck at all.  In a lot of ways, that is right, but at least Derek is still here.

The Yellow Ribbon Fund schedules special events for wounded warriors and their caretakers/families. 
Yesterday, Krystina and I were scheduled for hour and a half massages when Derek went off to get his flap.  It was a long surgery, Dr. Howard had my cell phone number, and the hotel was only a mile away, so I felt okay leaving base.  My car had other ideas.  Dead.  Not even a tiny little spark.  I went to text someone, "my car is deader than a doornail," and the swype feature on my phone changed the words so I texted, "my cat is deader than a toenail."  Nice.

Eliza from the Yellow Ribbon Fund kindly came and drove Krystina and I to and from the hotel so we could get our massages!  It wasn't the entire time because we were late, but it felt so good!
My car is a new lease so it should have been fine sitting for two weeks, but I guess not.  I have not had time to call Ford Roadside Assistance, but a nice nursing student, Mark, who was working with Derek tonight offered, "do you want me to jump you tomorrow night."  Interesting choice of words, kid.
So, anyway, yesterday morning Derek did get a flap.  After a weekend of high blood pressure, so high that the doctors gave him lasik to try to get some fluid off him and get the pressure down, he once again bottomed out under anesthetic.  So, he got the TEF.  His arm is attached to his chest for the next three weeks.  He was given a nerve block in his shoulder to numb the arm, so hopefully that will keep him somewhat comfortable.

Didn't work well last night.  He did not sleep and was very uncomfortable.  We stayed at the hospital with him until almost one a.m., and I was back there this morning at 07:15.  Sleep?  What's that?

After his surgery, he was supposed to go back to the ward.  Derek's lungs had another plan.  Not only did his BP bottom out during the surgery, but his respiratory status did as well.  Instead of to the PACU, he was sent to SICU on a vent.

After a couple of hours, they were able to wean him off the vent, but the decision was made that he was to stay in SICU for the night for flap checks, which could be done on the ward, but Dr. Howard wanted the one-on-one nursing care.

Unfortunately, he did not get that care today.  His nurse was horrible!  Not only did I complain to the charge nurse today, but I am filing a complaint tomorrow, and Derek said he wants to file one!  So, we listed all of our complaints tonight, and I will go file what he wants said tomorrow.  He said it was the worse care he has ever gotten!

Not only did she fail to do the flap check every hour, she "forgot" to get him ice until she was asked a couple of times (she has one patient), she came in to unclamp the G tube and then walked out without doing it so I found someone else, she did not drain any of the fluids all day, no pin care, I did the trach care, etc. 

Derek had an ice pack on his forehead and a fan blowing in his face yet she took his temp with the forehead thermometer.  I told her that was not an accurate reading, and she said, "well, it's normal" and walked out.  I called her back and repeated myself and explained the conditions.  She said she would have to look for an oral one.  Three hours later.  She came to check his temp again on his forehead, and I stopped her.  She said, "I guess we could turn off the fan for a few minutes" and walked out.  Did she want me to turn it off?  She didn't ask me to, and I didn't.  I walked out and found someone to go get an oral thermometer like she was supposed to do hours before.  I knew he didn't have a temp, but it was the principle.

Derek had a Fentanyl patch for pain on his chest.  We believe it was taken off during the surgery because of its placement.  But just to be sure, they said it would be safe to put a new one on at noon today.  She walked in at nine with it.  I asked her to get me a doctor to make sure it was safe.  She claimed she called the pharmacy and they said it was fine.  I asked her if the pharmacist was a doctor, because I told her I needed to speak with a doctor myself.  An hour later a doctor walked in.  Minor, but when a patient or family member wants to speak with a doctor about a safety or medical concern you get a darn doctor!
She transferred him to the ward with expiring medications, no machine for his tube feeds, no pumps for his medications, etc.  All of it went with him to SICU, so it should have come back with him.

The worst thing she did concerned the g-tube.  Dr. Bograd was very specific with me and the nurses on the ward about its use.  Unclamped all the time, draining to gravity, and then clamp it for a half hour every four hours.  This way most of what he eats (full liquids) will drain out, which will allow him to eat and drink, but keep him from getting naseous until his stomach wakes up, hence the clamping for short periods.  She read it the other way - clamped all the time and only unclamped for a half hour every four hours.  I didn't notice until after he had breakfast and nothing was draining.  I checked the bag and called her.  She argued with me!  I told her to find me a doctor immediately.  Two hours later, I ran Dr. Bograd down in the hall.  I had been looking for someone the entire time while trying to keep an eye on Derek.  He said he felt fine, so I didn't scream for a doctor from the door, but I wanted it fixed.  Dr. Bograd said, "you're looking exasperated."  You think?!?!  He fixed it.  I love him.

She really didn't know what to make of me when the x-ray techs showed up to x-ray his pelvis.  I asked why.  I was looked at like how dare I.  Oh well.  If you are going to be pulling him apart for an x-ray, I want to know why.  She called ortho who said it was to check on the status of the pelvis for possible removal of the x-fixes in two or three weeks.  And they needed to do an x-ray today?  The day after his flap?  When he was in a lot of pain?  I told them to get someone from ortho to come and see me and sent the techs packing.  I haven't seen ortho yet.  Dr. Borgrad thinks they are afraid of me.  Am I really THAT scary?  I asked Dr. B how he would be if one of his kids was lying in that bed.  He said he would be worse than me.  That's all I needed.  Dr. Goodlett says I love that line since I seem to use it a lot.  It humanizes the patient for some of the doctors.

Dr. Howard said to her and me this morning that he wanted to be in Derek's room when they transferred him to the new bed and to call him when we were on our way.  We were going to put him back on the red bed because it has better chest PT built into it and take him off the air flow bed.  Dr. Howard wanted to check the arm during the move.  The orders came in, and she never called him.  She sat on her fat butt waiting for Dr. Howard to come down. 

I said to her a couple of times that "Dr. Howard" needed to be called, and she said she called "plastics" and they were in surgery.  Dr. Howard was waiting for us on the fourth floor for a while.  She never called him.  I finally spoke with him, and he said he was waiting for us.  The move to the new bed went well, but the new bed hurt the sores on Derek's backside, so Dr. Howard made the decision to move him back to the other bed.  He said he would talk to respiratory about the chest PT.  I loved seeing Dr. Howard and a couple of other doctors in there lifting and making sure he moved the right way.  That was team work.
The good news is the flap looks great at we are back on the ward!  I am so over SICU.  Whatever longing I felt is gone.

And we've got Dr. Goodlett back.  He's the intern on the floor, and I love him.  He is so good and so attentive.  He let me vent and took great care of Derek.  He stands there smiling with his cute little dimples while I vent, and when he really wants to calm me down, he shows me picture of his precious baby girl.

All I ask is that you do your job, give Derek the care he deserves, communicate and be polite.  Is that too much to ask?  For some, it is.

I was told the definition of insanity is doing something over and over hoping for a different result.  Well, I am trying over and over to get some of these teams to work together, communicate and not make me fight so hard every day.  I am certifiably insane.

Derek and Krystina had a laugh riot and bantered a lot these last two days.
K: "OMG I can't touch you anywhere cause it would be ow you're pulling my wire, ow you're pulling my tube!"
Derek: "I GOT BLOWN UP!"
K: "well gee, I didn't know that the day your mom called me, thanks for explaining!"
Derek: "I broke it down for you Barney style"

Krystina put an icepack on his head and apparently, he thought it was too hard:
Derek: "what is wrong with you?! You need help, you just smacked me with an icepack"
K: "figure it out and help yourself now, I'm done"
Derek: "no!  stop!  I need help! I need an adult! But you don't count cause you're short"

K: "Derek, do I REALLLLLY have to marry you?"
Derek: "uhm, YEAH!"
Our Derek is back.

This has been a fun two days.  Hopefully tomorrow will be calm.  No surgery!  Woot!  First week with only two surgeries scheduled!  Derek is getting better all the time.  One wound vac, only two surgeries, it's getting there!  A few steps backwards this week, but so many more steps forward!

He looked at me tonight and said, "Thank you, Mom.  I love you.  You've done so much for me already."  Made my year.  He told one of the nurses he would not be where he was if not for Krystina and me.  The nurse agreed.  The nurse told him that he would still make it, but it would take him a heck of a lot longer, and that if he was the one lying in that bed, he would have no one by his side, so Derek is lucky.  That breaks my heart to think of the soldiers who have no one. 

Derek needs me right now.  I cannot be anywhere else.

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