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Friday, February 27, 2009
Saturday, February 21, 2009
Back Off the Eiger
It's been a rather nasty February for respiratory problems. We've seen more than our normal share of respiratory syncticial virus infections in adults. That of itself is unusual, as is the number of staff members (usually a robust group) who have used sick days due to pneumonia.
Darla works at another hospital. She had been getting recurrently sick and was not improving. Her lungs rattled like an old washing machine, a moist cough persisted, and she had no energy to work.
Doctors suspected a possible lymphadenopathy and performed a mediastinal biopsy, during which Darla suffered a pneumothorax and her right lung collapsed.
So things weren't going so well.
After that, doctors also recommended endoscopy. During that procedure Darla's esophagus was perforated and subsequently she got really fucking sick. So they shipped her off to us. There's some surgeons at our hospital who have good reputations for fixing these kinds of problems.
Her lung required a thoracotomy. That's big enough a surgery alone. But the espophageal tear was messy. Afterwards Darla had three drains placed along her lower right flank, one which was internally very near the esophageal abscess and two others to suck away fluid that might accumulate in the pleural and peritoneal spaces.
The right scapular incision for the lung surgery ran 20 staples long. About 7 inches.
They placed a gastro-tube to drain and decompress her stomache and a jejeunostomy tube provided tube feedings. The mid-abdominal staple line ran 15 staples long; just big enough for the surgeon to get their hand in there. Maybe 5 inches.
Darla dealt with it. She was always up walking around. I was able to help her with pain control, balancing on that line between discomfort and somnulence. Her bowels woke up nicely, the tube feedings maintained her energy level, and she was compliant with the strict order not to take anything by mouth until the doctors were sure that the espophagus would not leak post-operatively. That would be really bad.
Her friends from work visited, as did her protective and gentle Richard-Gere-look-alike boyfriend Casey. Over the few days I worked with her she improved steadily and everybody was thinking that in a day or two she might get some of the tubes removed and go home.
A swallow test was scheduled to evaluate her esophagus and we began to set up home services for her continued tube feedings. She would need that for a few weeks yet. After normal oral fluid and food intake resumed the G and J tubes could be removed during a visit to the doctor's office. Her main problems were resolving.
But we still have no fucking idea why she was getting so sick in the first place.
Darla works at another hospital. She had been getting recurrently sick and was not improving. Her lungs rattled like an old washing machine, a moist cough persisted, and she had no energy to work.
Doctors suspected a possible lymphadenopathy and performed a mediastinal biopsy, during which Darla suffered a pneumothorax and her right lung collapsed.
So things weren't going so well.
After that, doctors also recommended endoscopy. During that procedure Darla's esophagus was perforated and subsequently she got really fucking sick. So they shipped her off to us. There's some surgeons at our hospital who have good reputations for fixing these kinds of problems.
Her lung required a thoracotomy. That's big enough a surgery alone. But the espophageal tear was messy. Afterwards Darla had three drains placed along her lower right flank, one which was internally very near the esophageal abscess and two others to suck away fluid that might accumulate in the pleural and peritoneal spaces.
The right scapular incision for the lung surgery ran 20 staples long. About 7 inches.
They placed a gastro-tube to drain and decompress her stomache and a jejeunostomy tube provided tube feedings. The mid-abdominal staple line ran 15 staples long; just big enough for the surgeon to get their hand in there. Maybe 5 inches.
Darla dealt with it. She was always up walking around. I was able to help her with pain control, balancing on that line between discomfort and somnulence. Her bowels woke up nicely, the tube feedings maintained her energy level, and she was compliant with the strict order not to take anything by mouth until the doctors were sure that the espophagus would not leak post-operatively. That would be really bad.
Her friends from work visited, as did her protective and gentle Richard-Gere-look-alike boyfriend Casey. Over the few days I worked with her she improved steadily and everybody was thinking that in a day or two she might get some of the tubes removed and go home.
A swallow test was scheduled to evaluate her esophagus and we began to set up home services for her continued tube feedings. She would need that for a few weeks yet. After normal oral fluid and food intake resumed the G and J tubes could be removed during a visit to the doctor's office. Her main problems were resolving.
But we still have no fucking idea why she was getting so sick in the first place.
Friday, February 20, 2009
Monday, February 16, 2009
Choking Irony
I had a chance to meet up with some relatives this past weekend. My cousin's wife is a physical therapist and she told me an interesting story about a young patient who suffered from bulimia and anorexia.
The young woman, being quite active, was on a full sports scholarship to a major state university. It was probably the disease which enabled her to obtain this, because of her intense activity level. She was on her third running workout of the day when she collapsed in the showers. Nineteen years old.
Enemas, purging, and hyperactivity has caused her electrolytes to become unbalanced; her potassium level had dropped so low that it caused cardiac arrhythmias. That in turn caused the blood flow to her brain to drop and she fell unconscious due to lack of oxygen in the brain.
She survived but her level of functioning has dropped precipitously. She has no ability to form short-term memories so she can no longer go to university. She has difficulty walking and controlling fine motor movements. And oddly enough, she suffers from acoria: she is constantly hungry because she has lost the ability to feel satiated after eating. Not that she would even remember having eaten in the first place...
That makes her easy to motivate, said my cousin's spouse, because they can get her to work hard in therapy by offering her food rewards.
The young woman, being quite active, was on a full sports scholarship to a major state university. It was probably the disease which enabled her to obtain this, because of her intense activity level. She was on her third running workout of the day when she collapsed in the showers. Nineteen years old.
Enemas, purging, and hyperactivity has caused her electrolytes to become unbalanced; her potassium level had dropped so low that it caused cardiac arrhythmias. That in turn caused the blood flow to her brain to drop and she fell unconscious due to lack of oxygen in the brain.
She survived but her level of functioning has dropped precipitously. She has no ability to form short-term memories so she can no longer go to university. She has difficulty walking and controlling fine motor movements. And oddly enough, she suffers from acoria: she is constantly hungry because she has lost the ability to feel satiated after eating. Not that she would even remember having eaten in the first place...
That makes her easy to motivate, said my cousin's spouse, because they can get her to work hard in therapy by offering her food rewards.
Sunday, February 08, 2009
More Songs About Food But Not Buildings
Oh man oh man, AJ's had 4-6-count shrimp. The oranges were better than they looked, and the green grapes were on sale. We got some sourdough and munched on Idiazabal, a slightly smoky Basque sheep cheese, and paired it with super-creamy Brillat-Savarin cow's milk cheese.
I basically just butterflied the OMG shrimp and tossed them into a butter/garlic/olive-oil/orange-zest sauce with some chunks of Mahi-mahi, a generous handful of sea scallops, and some Tilapia to round out the stew.
The kid said it was the best meal they ever had. Wow. Score. Of all the things... fruit, bread and cheese.
I had Virgil's Root Beer, the kid had Gerolsteiner fizzy water, and the spouse (atypically,) went for a lemon-grass soda. I love those things.
So what we have here is one of your typical "what we're eating now" posts that you see over in the Eschaton festivals of Haloscan.
In a short time we will probably not ever be eating such things. Few will. One family out of a thousand. Some will have next to nothing. Some already suffer so.
You really never know which meal will be your last.
I basically just butterflied the OMG shrimp and tossed them into a butter/garlic/olive-oil/orange-zest sauce with some chunks of Mahi-mahi, a generous handful of sea scallops, and some Tilapia to round out the stew.
The kid said it was the best meal they ever had. Wow. Score. Of all the things... fruit, bread and cheese.
I had Virgil's Root Beer, the kid had Gerolsteiner fizzy water, and the spouse (atypically,) went for a lemon-grass soda. I love those things.
So what we have here is one of your typical "what we're eating now" posts that you see over in the Eschaton festivals of Haloscan.
In a short time we will probably not ever be eating such things. Few will. One family out of a thousand. Some will have next to nothing. Some already suffer so.
You really never know which meal will be your last.
Friday, February 06, 2009
Songs About Buildings But Not Food
What are hospitals for?
What are people for?
Hospitals are for nurses. Hospitals have no reason for existing other than to serve nurses. We need places in which we can function on behalf of our patients. Garages, shopping malls, celebrity kitchens, and ball parks are insufficient for this purpose.
Respiratory therapists, aides, physical and occupational therapists, dietary aides, nutritionists... all these people and many more help the patients too and therefore help the nurses. But if those people don't show up, nurses are typically expected to perform some of their duties, too.
I once worked in the intensive care unit of a rural community hospital. On the night shift, the respiratory therapist was home on-call. If one of the ventilators started to fuck up for some reason, he only lived about ten miles away. No problem, then.
Doctors are walk-ons. Big-stars, but bit players. Character actors. They stroll onto the stage, sing their big aria, everybody claps, then they leave. We nurses pester them on the phone a lot because they forget stuff. They're actually very helpful and I can honestly say that all the doctors I work with are marvelous, immensely talented, and essential people. But they're not nurses.
People? They're basically for entertainment, which they provide endlessly. When they're not just plain fucking annoying, that is. Congressional Republicans for example.
Like if a patient develops a really nasty sudden gastrointestinal bleed and pukes a bloody bucket of eel-like red squirmy emesis all over, that's entertainment. Run fluids, get labs, transfuse blood, rush him to Endoscopy; that's pretty cool and it certainly provides meaningful work.
John Boehner, though, he's just chicken shit. He's just not for anything.
What are people for?
Hospitals are for nurses. Hospitals have no reason for existing other than to serve nurses. We need places in which we can function on behalf of our patients. Garages, shopping malls, celebrity kitchens, and ball parks are insufficient for this purpose.
Respiratory therapists, aides, physical and occupational therapists, dietary aides, nutritionists... all these people and many more help the patients too and therefore help the nurses. But if those people don't show up, nurses are typically expected to perform some of their duties, too.
I once worked in the intensive care unit of a rural community hospital. On the night shift, the respiratory therapist was home on-call. If one of the ventilators started to fuck up for some reason, he only lived about ten miles away. No problem, then.
Doctors are walk-ons. Big-stars, but bit players. Character actors. They stroll onto the stage, sing their big aria, everybody claps, then they leave. We nurses pester them on the phone a lot because they forget stuff. They're actually very helpful and I can honestly say that all the doctors I work with are marvelous, immensely talented, and essential people. But they're not nurses.
People? They're basically for entertainment, which they provide endlessly. When they're not just plain fucking annoying, that is. Congressional Republicans for example.
Like if a patient develops a really nasty sudden gastrointestinal bleed and pukes a bloody bucket of eel-like red squirmy emesis all over, that's entertainment. Run fluids, get labs, transfuse blood, rush him to Endoscopy; that's pretty cool and it certainly provides meaningful work.
John Boehner, though, he's just chicken shit. He's just not for anything.
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