Monday, September 26, 2011

Nurses Rock

First of all, I need to send a huge thank you to Karin and Bob Ruppel.  Thanks to their unselfish act of donating a van to Derek, I have a way of transporting him to and from home when he becomes an out patient without having to worry about renting a van (which I have been told is a lot of paperwork and a hassle).  It takes a huge load off my shoulders.  They are wonderful people.  Thank you also to Brian for making this happen.

This weekend was horrible. 

The simple parts were his white count hovered from 10.4 to 11 and then back down to 10.  The doctor came in and changed the wound vac on his right hip because it stopped working.  The awesome day nurse, Sarah, suggested lasex (sp?) to help reduce the fluid retention and it started to work!  And Yvette came for the weekend.  Other than that?  I think I seriously need that restraint team.  Derek suffered, and I am on a rampage.

I walked in on Saturday morning to a respiratory emergency.  It happened four more times on Saturday.  He desatted several times and he needed deep suctioning, breating treatments, and constant monitoring.  More than the ward could provide.  He also put out pink froth, which I had been told in the past was not a good sign.

Due to pain in his ribs, an EKG was ordered and it showed a positive inversion of the T wave so they ordered cardiac enzymes and a chest x-ray.

A decision was made by the day team that he would be transferred either to telemetry (due to the heart question) or the ICU due to the breathing issues, but that it would be left to the doctors on call overnight.  They came in at 19:00 and said they would make the call.  The bed was set up, things were unplugged, we were packed and waiting. 


The charge nurse was on the phone screaming at the doctor that Derek needed to be in the ICU because he needed more than the ward could provide and a decision had to be made. 
No decision.  They came and spoke with me.

Finally, at 21:00, they said they were leaving him where he was because his stats were fine and the nurses could handle it.  ????

The charge nurse, the awesome LT Bennett, did everything she could to get Derek to the ICU where he belonged.  She made phone calls, she yelled, she did all she could.

Derek's nurse, the fabulous Jenea Maxwell, and the corpsman Willie Allen, stood at Derek's bedside all night taking care of him.  She did the work of an ICU nurse with two-on-one care.  Derek's stats dropped to 89, and hovered in the low 90's most of the night.  I sat there staring at him all night, watching his nurse and the corpsman do their thing.  Every time the idiot doctor walked in, the comment was, "he's doing okay now."  Well, you should have been here ten minutes ago!  Maybe we should have left him blue for you, idiot!  I guess going blue four times during the day wasn't enough and constant care all night isn't enough!
The orders were changed that Derek is to be suctioned every two hours due to his increased mucus plugs, and they are putting a humidifier in his room.

On Saturday, his tube feeds started coming out his G tube (they were going into the J tube), so they did an x-ray of the abdomen, and it showed that the J tube was in the stomach.  They called IR, but IR decided not to do anything and let him sit there not getting any feeds.  Cue the rage.  Then Sunday morning IR said to start the tube feeds to see if they made him naseaus.  Basically, I was told they were trying to purposefully make him sick.  The cooler heads of the few ward docs I trust prevailed and IT scheduled the procedure.
What a clustermuck.  The procedure took over three hours and failed miserably.  Derek felt most of it, and he said they were yelling at the woman to increase the pain meds, which didn't work.  They could not replace the J tube, so he is getting no tube feeds.  He only has a G tube and probably won't have a J tube until Thursday, and they cannot let him eat that much because his stomach has not been able to handle it.
Dr. Cho said it is clear from the chest x-ray from LAST SUNDAY (the 18th) that the J tube was in his stomach.  Not possible.  If it was, the tube feeds would have been coming out the G tube, right?  I am not up on all the medical jargon, but I think I understand that part, and that is what was explained to me by another doctor this morning.  I also thought a chest x-ray didn't go low enough to show the entire J-tube, and the doctor this morning confirmed that.

Now we get back to the ward at about 19:00.  Dr. Rodriguez reviewed the x-rays and okayed him for drinking and the use of the G tube for meds, as long as not much else went into his stomach.  But since it had to be put into the system as an order, we had to wait for the nighttime on call doctor to actually enter it into the system.  I went and got Derek his milkshake because Dr. Rodriguez had okayed it, but we just had to wait until the order was entered.  Good luck with that.

The nurse paged and called the on call doctor for six hours.  At midnight, he was NPO'd because of surgery today.  The order was finally put in around 01:00.  Had we listened to this doctor, he would have missed his milkshake and his night meds.  Thank God his nurse has a brain and I am sneaky.  Derek enjoyed that milkshake, and she gave him his meds based on Dr. Rodriguez' oral order.

I need to sit down with Dr.Perdue and get this straightened out.  As of right now he is getting no tube feeds, no nutrition beside the IV, no nothing.  I am furious.  He wants to get strong and get better, and these doctors need to get their heads out their respective butts and get with the program!!!

In the PACU this morning at 05:30 for the flap and other procedures, Derek revealed a horrifying tale from when he was in the medically induced coma (and it explains so much about how he was acting - I need to talk to Dr. West).  He said it because they were talking about keeping him sedated for 24 hours after the flap and he panicked.  He does not want to be sedated.  It was a tale of horror and terror from which he could not awake.  It is still so vivid to him. 

After PACU this morning, Yvette and I walked down to CCU to see where Derek will be after the surgery and who he will have for his nurse.  Priscilla!  Love her!  She came up to us and told us it was her, and I started crying!  The comfort zone.  I felt like Derek was finally safe again.  I love the nurses on the ward, but those overnight docs scare me.  At least for the next few days, I will rest easy.  Then we can try again.
This is quite the journey.  You must be hypervigilant and ever watchful for everything.  They slip in and try to talk to Derek about procedures and medications when I am not there, and he says "yes" when he doesn't know what he is talking about.  He almost said "yes" to methadone again!  Hell no!  I nixed it.  He is with it and can discuss any procedure, but with all of the narcotics and not being aware of all of the history he has been through, he still needs me.  He can decide who to call, who to allow into his room and when with respect to visitors and VIPs, but he still needs someone to help him with the medical end of this.  This is a horrible battle, but one we will fight to the end.

To the top, Derek.  All the way.

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