Wednesday, August 22, 2007

Carry the Day

As I walked down the hallway to place my bag lunch in the refridgerator in the staff lounge, I peeked into each patient room as I strolled by. One had a patient who was already up in her chair, and even before my stride took me far enough in front of the door to her room I could hear the tell-tale sound of her using her incentive spirometer. Out of bed, neat and clean, waiting for breakfast.

"That would be a good patient," I said to myself.

Then I heard the beeping of a bed alarm and a couple of the night-shift nurses quickly went to a room up ahead. As I neared that room door I could pick up on the smell and I heard the nurses coaxing the patient back to bed and talking about cleaning up.

"That one not so much," I thought as I wondered how my day was going to be.

After doing my little morning routine I received my assignment, which included both of those people. Even before getting report I was in with "the jumper," helpng to put Humpty back together again.

He'd pulled out his intravenous line and bloodied himself. His catheter had become disconnected from the drainage bag and urine leaked onto the floor along with IV solution; a "banana bag" of fluid that included riboflavin, which is yellow. Alcoholics get that and other vitamins such as thiamine and folic acid added to their regimen. Then there was the loose stool.

A yard sale.

He had Korsakov's Syndrome as well as pancreatitis and a constellation of other ailments. When the residents tried to explain to him that his pancreatitis was due to years of alcoholism, he would shortly thereafter ask them "how did I get pancreatitis?" and they'd explain it again but he'd forget.

When they also told him that his liver was severely damaged he asked them "Well what about my other ones?" not realizing that he only had just the one, He was under the impression that he had seven or eight other livers which would carry the day for him.

Korsakoffers also confabulate sometimes.

After a few hours he was doing better. Often such patients have difficulties on the night shift that do not manifest during daylight hours. People with various kinds of dementia can also have this sundowner's syndrome.

Anyways, I got another IV line into him and the doctors decided to have him go without the urinary catheter. I fed him enough Librium to stop an elephant stampede but he was wide awake all day.

Sometimes he would walk out to the nursing station wheeling his IV pole with him to ask us questions like "when would the doctors be here?" after, of course, they had just left his room.

The other patient was recovering from the removal of a five-centimeter spindle-cell tumor from their right lung. Her chest tubes were out, we pulled the epidural line and placed a little dressing over its insertion site, and she was doing well but had developed atrial fibrillation. She spent another night and converted to normal sinus rhythm after a few bouts of aberrantly-conducted a-fib in the 160's.

Actually, she converted just as one of the pharmacists was handing me a bag of Amiodarone to hang along with Cardizem. She ended up taking those medications just orally.

Her tumor biopsies came back benign. The photographs of it in the chart showed a neat little oval ball. She'd never been a smoker and did not work in a suspect enviroment. Nobody could really explain how it had developed, but it was gone now and not likely to recur.

The main difference between the two patients was that one had participated in their own healthcare, on a life-long basis, and the other obviously had made alternative plans. It hadn't worked out so well.

1 comment:

DisappearingJohn said...

A great way to put it!

The sad part is that the person who invested in their health early on probably also has a good job, with health benefits, and will still get stuck paying their portion of a huge bill.

The other probably is either "disabled" due to their self-destructive ways, or unemployed, which means the taxpayers will pay for their care in its entirety