Sunday, May 23, 2010

530 lbs.

Though many of their residents are somewhat sick, in the sense that they are chronically ill and cannot live independently, nursing homes are not hospitals and there are many rather simple interventions that cannot be done in that setting. For example. most nursing homes cannot provide sustained treatment with intravenous medications. They just don't have enough licensed staff to provide such. So if a resident medically comes to require that sort on intervention, they must be transferred to a hospital.

That is one of the beautiful things about a good nursing home nurse. They can tell when it's time to move a patient.

I have to congratulate the people who discovered that this particular patient had gained thirty pounds. Not real weight as in fat and muscle, but dangerous "water-weight." Because the patient weighed well over five hundred pounds to begin with.

I don't know how they caught this. Did she have a bed with a built-in scale? I do not recall. Even those become decalibrated and useless on a day-to-day basis. Did they have a sling scale that went up that high? I cannot imagine the practicality of doing this. The logistics involved just to roll this woman onto a bedpan were complex and involved four people. Let alone getting her out of bed and onto a scale of some sort.

Anyways, they discovered the dangerous and relatively sudden weight gain (over a month's time only,) and she was sent to us. We diuresed her with intravenous Lasix. Bless the nurse that somehow found a vein to establish IV access. It wasn't me. The woman urinated gallons and gallons. Bless the nurses that inserted the urinary catheter, too. That little procedure took five nurses; two to hold each leg and one to fish around and insert the tube.

The woman responded well to treatment. She still weighs over five hundred pounds and that will kill her someday soon, but in this case, no. Not this time.

We were all surprised when the patient's mother and sister came to visit, for they weren't "big people." Actually they were rather athletic-looking, not even zaftig. Nearly slim. They said that there had been other quite big people born into their family though. As one would expect.

Saturday, May 15, 2010

A Bevy of Quail

You cannot say that nothing is as it seems.

We saw a bevy of quail yesterday, the little ones only a couple inches tall scurrying along with their parents.

If I hadn't checked his blood pressure, if I'd gone to lunch instead, he'd probably had circled the drain. Instead I went hungry.

It isn't enough that you have someone to love. That someone has to be near you much of the time. Close counts.

Caramelized onions and prosciutto ravioli in a pink vodka sauce.