Good Morning.
This entry is a little early.
But I needed to get some things off my chest...and out of my head.
We lost my cousin Stephen "Nooney" Lance yesterday. The funny thing is that when I heard that he had been in a bad accident, it never crossed my mind that it meant he could die. Especially since right after the accident, reports said that he was already dead and I know how fast (fake) bad news travels at home. So when I finally spoke to my Mom to see if she had heard how he was and she said he had been airlifted to MUSC but they thought he was going to be ok, it seemed like it was going to be like the scrapes Nooney has had before. My dude even went "missing" for a few days once. But the reports of his demise have always been greatly exaggerated. I figured this would be the same situation. And when I went home this weekend, I'd look across the trees and see him in the backyard and hear him yell my name and say "What's happenin' cuz?" in that goofy voice of his or see him drive by in the GMC, tucked low and leaning to the side.
I guess you get to a point where life is so full of our daily comings and goings that we don't think about death as a part of everyday life. But it is.
I realized this morning that in my short time as a nurse practitioner, the thought of death and dying, as it relates to my patients, has never really crossed my mind.
It strikes me as a little weird. And I am trying to figure out how I, as a medical provider, that I don't think about it more.
Is it selective amnesia for my own comfort? Indifference? Am I out of touch? Desensitized? Suffering from a god complex?
I just don't have a good explanation.
When I worked as a floor nurse right out of undergrad, I treated every patient as if they could die at any minute. At the time, I was just that terrified of what I had chosen to do as a profession. Better safe than sorry, right?
I remember the first time a patient died on my watch, I was about 6 months out of nursing school. The shift changed and the report that I got from the day nurse gave every indication that the patient was ok. I remember clearly hearing her say, "He is dehydrated and anxious. Just give him some Ativan and he will be ok."
What I have always had is an internal instinct to cover my @$$ in those situations, so I ALWAYS reviewed each of my patient's charts at the start of my shift for things like new orders, labs and/or test results. So after report, I pulled the patient's chart and noticed he'd had an abdominal CT done. I don't remember the results specifically but the report basically said that the patient's belly was full of "sludge" and his organs "could not be adequately visualized."
All of my other patients were stable for now. And because the off going nurse never mentioned the CT to me, something told me that it meant the doctor did not know about it either. I brought it to the charge nurse's attention. She paged the doctor while I went to assess my patient.
When I walked into the room, he was sitting on the edge of the bed, on 2 liters of oxygen, but still completely short of breath. He skin was cold and pale. He was sweating non-stop. His pupils were dilated. His pulse was racing. And his belly....
His belly.
That's what let me know something was terribly wrong.
I laid my stethoscope on his stomach and heard absolutely nothing. He was so bloated that I could plainly see the veins dilate and stretch across his swollen belly. I could not palpate his abdomen, because the skin was stretched taut like drum. And the beautiful tympanic sound that you should hear when you tap on someone's belly, was replaced by the dullest "thud" I had ever heard.
I didn't know what was wrong, but I knew we needed to figure it out quick. I yelled for the charge nurse to come in. We didn't have a Rapid Response Team at the time and it wasn't technically a code situation. But we had to do something. She still had the doctor on the phone, so I asked her to get orders to move him to the ICU.
The patient's wife was in the room and we explained to her what was about to happen and she seemed relieved. She said that she'd been asking all day for something to be done, but everyone seemed to think that he was ok where he was. She thanked us and just as the charge nurse and I turned the corner to walk out of the room, it happened.
It sounded like the patient had belched really loudly. Then I heard his wife scream. I turned on my heels and looked back to see the patient projectile vomiting what I could only describe as black bile. Inhuman amounts of black bile. The charge nurse screamed for the secretary to call a code blue and we made it over to him just before he fell forward onto the floor. God gave the us the strength to get him back in bed and on his side so he would not choke on the bile. As we cleared his airway, turned him on his back and started CPR, the code team rushed into the room and took over. This all happened in the matter of about 60 - 90 seconds, but it felt like a lifetime.
His heart had stopped. The monitor showed pulseless electrical activity or PEA, which meant that there was some electrical activity, but no heartbeat. Epinephrine. Vasopressin. Atropine (it was still on ACLS back in 2005). Paddles. No change.
They intubated him and moved him to ICU. The doctors explained to the wife that the patient was brain dead. The vent was breathing for him and once it was removed there was virtually no chance for survival. His wife agreed to have the vent removed, but asked that they allow her children time to come in from out of state before it was removed. They agreed.
I didn't hang around the ICU long enough to know what else happened. My shift had started at 7:15 that night and all of this transpired before 8:30. I had 5 other patients that I had not laid eyes on yet. I had to get my brain to shift gears from the thoughts of the dead, who I could do nothing for, back to the living who needed my care.
I think something happened to me then. I'd never seen anyone die before. To that point, it was enough that I'd seen someone dead in a casket. But to witness them passing from this life to the next? It was almost too much. That night I actually considered not being a nurse anymore.
I struggle with the thought of death. So I try not to think about it. It sends a cold shiver down my spine. I am dismayed by it. Weakened by it. Heartbroken by the fact that it can come and take my most beloved, irreplaceable things away from me. That it could take me away from those same things.
Maybe that is why I don't bother it, until it bothers me. Maybe that's why, I never consider it as an option for my patients because to be effective, I have to always feel like there is something I can do. The thought of death, you see, renders me powerless and sorrow seems to be my only recourse.
I will think about Nooney (and death) constantly for the next little while. I will wonder if this was God's way of saving him from an earthly fate worse than death or if it was really just his time to go. Either way, I applaud the folks that never gave up on my dude, even though there might have been reasons other people thought they should. Life and hope go hand in hand. No matter what the situation might be.
Its easy to say that in a perfect world, all of our chains would remain unbroken.
But my guess is that world would also be absent of God's will and our promised salvation.
And nothing about that could ever be perfect.
Its like my granddaddy, Buh Norman used to say, "Chile, you need to try to live until its time to die."
That's right Granddaddy.
I don't think we should bother death, until death bothers us.
RIP Cousin Nooney. Imma see you again.
Towanna
Wednesday, September 26, 2012
Thursday, September 20, 2012
Anybody Can Get Slapped...
I figure that since I am home with my 4 year old and her crud today, I'd take some time to write a new post while she naps. Wonderful thing that Benadryl is. I remember once when I gave it to her, she must have rolled out of bed because when I went in to check on her she was on the floor, wedged between the bed and the wall, fast asleep.
She didn't even stir when I picked her up to put her back to bed. And it would have scared the "ESS" out of me...except she was snoring like a grown man. And anyone whose heard my child snore, knows that is all the sign of life you need.
She's gets that from her Mama. I snore like 2 grown men when I am really tired. Gotta get that good chainsaw sounding sleep in every once in a while.
Helps to replenish your sexy. But at 3:00 in the morning, Hubby would probably disagree.
Anywho, its been a good few days at clinic this week. As usual, there is very rarely a dull moment to be had. Between the staff and the patients, I don't think there is a completely normal person in the bunch. Not even AF. I think her "crazy" is a bit more normal than the rest of our "crazy," but she fits right into our collective "crazy" nonetheless. We also have a fairly new member of our team, DP, who at first glance you would think was super quiet. I thought we might scare her off when she first began working with us, but now I plainly see that we definitely don't have to worry about that. She's so efficient and on top of things. And I think, you better not mess with her. Not only because the rest of us will come looking for you, but because I'm almost sure that if you rub her the wrong way, you'll get told off. Her "crazy" is quiet. But she is from off that water like me and KB, so she is probably still "crazy."
But there are 2 characters in the cast that the word "crazy" might not begin to touch.
Let me explain.
CK has some odd ways too. Real odd. When she eats a Snicker Bar, she eats the chocolate off of the top of the candy bar and then saves the rest for later. I guess it might be more odd that it bothers me so much. We asked her about it one time, but I don't remember what her reasoning was. And I probably don't remember because it didn't make sense to me. Another thing I find odd about her is that she eats Nilla Wafers like they are regular cookies. Again, I might be the odd one, but the only time I think that people should eat Nilla Wafers is if they are in banana pudding. Otherwise, it just doesn't make sense. And then there's the story about the drug test she took before she was hired on with us. It bothered me. But I am still investigating the situation because I think she was taken advantage of. I can't go into detail for REALLY FUNNY reasons, but just know that I'm going to get to the bottom of that foolishness on her behalf. Last week I asked her to stop responding to me with "ma'am." So when I called her name, instead of saying "ma'am" she said what I think I heard to be "Yurp!" Uh, no. I told her that if that was the alternative, "ma'am" would do just fine. If you ever meet her, ask her about "baby hair," taking "baby" sand to the beach, and why she doesn't think that people should have dogs as pets. No. For real. Ask her. Then tell me something isn't loose somewhere. (I am sure she has her eyes stretched wiiiiide open as she is reading this).
And then there is HL. Dear sweet, HL. Bless her heart. She is too funny. Almost to a fault. And usually without meaning to be. Last week, at one of the clinic sites where we share a really small office and one desk, she and I were sitting beside each other on one side of the desk. We were nowhere near close enough that we had to be touching at all, but every few seconds, she would step on my toe. The first couple of times, I didn't pay it much mind. But after the 4th or 5th time, my pinky toe couldn't take it anymore and I threatened to punch her if she did it again. I thought maybe she was doing it deliberately, but I actually think she has so much energy that she couldn't be still if she wanted to. And then there was last Friday when we were sitting in our makeshift office. She and AF were behind their partition on one side of the room and CK and I were behind our partition on the other side of the room. I called out to HL and asked her if she could come over for a second. All I heard was her voice from behind the partition saying, "Sorry honey, but I'm sitting down right now." (O_o) Ok. But I think that was the point of asking her to come over. She got a pass for being a smart butt, because she wasn't feeling well that day. I wish I had time and space to tell you about her and her friends using Blue Magic hair grease as tanning lotion when they were in 7th grade. Or the fact that its her fault that "Bands A Make Her Dance" is currently our unofficial theme song. But I don't. So I will just say that I hope her lost rottweiler finds his way back to her in good health with the help of that dog whisperer that contacted them. Being sad doesn't suit her.
KB is going to escape unscathed this go round. But threatening your pretty little dog with a shock collar and breaking out in the "Cupid Shuffle" (or was it the "Wobble") in the middle of the street doesn't leave much question about where she falls in all this.
And yeah, yeah, yeah. I know its like the pot calling the kettle black.
But dis here is my blog.
Where anybody can get slapped.
But, duuuhh!!! Why would I slap myself???
Love you guys. I would not be here without you.
Towanna
She didn't even stir when I picked her up to put her back to bed. And it would have scared the "ESS" out of me...except she was snoring like a grown man. And anyone whose heard my child snore, knows that is all the sign of life you need.
She's gets that from her Mama. I snore like 2 grown men when I am really tired. Gotta get that good chainsaw sounding sleep in every once in a while.
Helps to replenish your sexy. But at 3:00 in the morning, Hubby would probably disagree.
Anywho, its been a good few days at clinic this week. As usual, there is very rarely a dull moment to be had. Between the staff and the patients, I don't think there is a completely normal person in the bunch. Not even AF. I think her "crazy" is a bit more normal than the rest of our "crazy," but she fits right into our collective "crazy" nonetheless. We also have a fairly new member of our team, DP, who at first glance you would think was super quiet. I thought we might scare her off when she first began working with us, but now I plainly see that we definitely don't have to worry about that. She's so efficient and on top of things. And I think, you better not mess with her. Not only because the rest of us will come looking for you, but because I'm almost sure that if you rub her the wrong way, you'll get told off. Her "crazy" is quiet. But she is from off that water like me and KB, so she is probably still "crazy."
But there are 2 characters in the cast that the word "crazy" might not begin to touch.
Let me explain.
CK has some odd ways too. Real odd. When she eats a Snicker Bar, she eats the chocolate off of the top of the candy bar and then saves the rest for later. I guess it might be more odd that it bothers me so much. We asked her about it one time, but I don't remember what her reasoning was. And I probably don't remember because it didn't make sense to me. Another thing I find odd about her is that she eats Nilla Wafers like they are regular cookies. Again, I might be the odd one, but the only time I think that people should eat Nilla Wafers is if they are in banana pudding. Otherwise, it just doesn't make sense. And then there's the story about the drug test she took before she was hired on with us. It bothered me. But I am still investigating the situation because I think she was taken advantage of. I can't go into detail for REALLY FUNNY reasons, but just know that I'm going to get to the bottom of that foolishness on her behalf. Last week I asked her to stop responding to me with "ma'am." So when I called her name, instead of saying "ma'am" she said what I think I heard to be "Yurp!" Uh, no. I told her that if that was the alternative, "ma'am" would do just fine. If you ever meet her, ask her about "baby hair," taking "baby" sand to the beach, and why she doesn't think that people should have dogs as pets. No. For real. Ask her. Then tell me something isn't loose somewhere. (I am sure she has her eyes stretched wiiiiide open as she is reading this).
And then there is HL. Dear sweet, HL. Bless her heart. She is too funny. Almost to a fault. And usually without meaning to be. Last week, at one of the clinic sites where we share a really small office and one desk, she and I were sitting beside each other on one side of the desk. We were nowhere near close enough that we had to be touching at all, but every few seconds, she would step on my toe. The first couple of times, I didn't pay it much mind. But after the 4th or 5th time, my pinky toe couldn't take it anymore and I threatened to punch her if she did it again. I thought maybe she was doing it deliberately, but I actually think she has so much energy that she couldn't be still if she wanted to. And then there was last Friday when we were sitting in our makeshift office. She and AF were behind their partition on one side of the room and CK and I were behind our partition on the other side of the room. I called out to HL and asked her if she could come over for a second. All I heard was her voice from behind the partition saying, "Sorry honey, but I'm sitting down right now." (O_o) Ok. But I think that was the point of asking her to come over. She got a pass for being a smart butt, because she wasn't feeling well that day. I wish I had time and space to tell you about her and her friends using Blue Magic hair grease as tanning lotion when they were in 7th grade. Or the fact that its her fault that "Bands A Make Her Dance" is currently our unofficial theme song. But I don't. So I will just say that I hope her lost rottweiler finds his way back to her in good health with the help of that dog whisperer that contacted them. Being sad doesn't suit her.
KB is going to escape unscathed this go round. But threatening your pretty little dog with a shock collar and breaking out in the "Cupid Shuffle" (or was it the "Wobble") in the middle of the street doesn't leave much question about where she falls in all this.
And yeah, yeah, yeah. I know its like the pot calling the kettle black.
But dis here is my blog.
Where anybody can get slapped.
But, duuuhh!!! Why would I slap myself???
Love you guys. I would not be here without you.
Towanna
Saturday, September 15, 2012
Blown Away...
Good Morning, Folks....
Its such a peaceful Saturday morning here in the Met. I think that we are going to the zoo today, so I got up early to clean and do some laundry. But I hate that part of my life, so I take frequent breaks while I'm doing it. And I thought that maybe this would be a good time for my weekly blog entry.
There's a movie called "Life as House" about a man named George who has cancer and all sorts of other problems, who simply decides to build a house before he dies. He's divorced and has a teenage son with his ex-wife. The son is a drug addict who can't stand him and steals his Percocets to get high with his equally strung out girlfriend. So yaddah-yaddah-yaddah and blah-blah-blah, by the end of the movie, this huge dysfunctional group becomes a distorted picture of happiness and they all become a part of the construction of the house. The man dies, but his ex-wife and his son, in the traditional movie cliche', find the strength to move on and decide to finish the house for him.
Ok. So what's the point of all that you ask?
Well, there is a line at the end of the movie where George, the main character talks about change:
"You know the great thing, though, is that change can be so constant you don't even feel the difference until there is one. It can be so slow that you don't even notice that your life is better or worse, until it is. Or it can just blow you away, make you something different in an instant. It happened to me."
I think that I am going to have new business cards and t-shirts made up for our clinic with this as our mantra. The clinic staff and I started this journey back on April 11th of this year. I remember that first day, it was just me and KB, in one cramped room with no admin staff at all. We saw 17 patients that day. All of them new patients. I know that won't mean a lot to many of you reading this, but those of you who do know, will appreciate what kind of feat it really is to have see 17 brand new patients, using one exam room and no admin staff. We worked from 8 that morning until 8 that evening. And that went on for quite sometime before a new shelter director came in and offered us a larger space to work from.
I was under so much stress at that time, that I actually ended up with a flare of my TMJ, which I had not had a problem with since undergrad nursing school at MUSC.
We have to also remember that I had only been a nurse practitioner for 5 months when this all started. I was terrified enough at the thought of independently taking care of patients on my own, but at least in the regular office, I had several other providers at my immediate disposal should I need help. Out here at the clinic, it was just me. And if I had a concern about the care of a patient, a phone call was my only lifeline to the outside.
But looking back on it, as hard as getting those clinics up and running seemed to be at the time, I never flinched, never second-guessed what I was doing. Mainly because I knew in my heart, I had not chosen to be there. But I had been chosen to be there. On top of that, I knew that in the form of KB, God had sent me something that I had never had: a completely like-minded spirit with the same motivations, desires, and ego-absent work ethic that you need to endure what we were tasked to do.
Now, almost exactly 5 months to the day that we opened those clinic doors, I can tell you that I completely understand what George must of felt like as he noticed the transformation that his life had taken. Because we were so busy all the time, not only did I not notice the awesome evolution of the clinic while it was happening, but when I finally did take notice just a few days ago, I was completely blown away what it had become and even more flabbergasted by some of the changes I noticed in myself.
When I was going through NP school at Duke, one of my last rotations was with. Dr. S., an OB/GYN in Conway and an absolutely brilliant lady with high expectations for the people whom work with her. And sometimes, in my experience with her, that combination could translate into a milder form of tyranny. I went into that office with her everyday, always worried about getting my hand slapped. There were not many days that I didn't get my hand slapped and in my mind, that mean that I had an uphill battle getting to where I needed to be as far as she was concerned. But on the last day of my rotation, after seeing the last patient, Dr. S. gave me a great big hug....and offered me a job.
I did not realize it then, but her constant correction of me was her way of showing me that she knew my potential and she fully expected me to work to fulfill it. I always keep that experience with her in the back of my mind, because when I worked as a floor nurse at the hospital, I had some really nasty experiences with some of the doctors. The running joke amongst the nurses was to ask the question, "Are you a doctor because you're nasty? Or are you nasty because you're a doctor?"
I know now that its neither. At some point as a medical provider, you began to totally grasp what it means to work in a profession where there is little room for error. When you are in charge of the direction of ALL the work that goes into a patient's care, you tend to forget your manners and other people's feelings. Its always business. Never personal (although there is still a line of respect to be drawn). So as much as I used to get upset at those rude doctors who acted like I was bothering them when I called them about their patient, I never in a million years would ever think I'd understand where they were coming from. But I do.
Talk about blown away.
This all makes me think about a post from my cousin, JJ's, Facebook page a while back. (BTW, he has an awesome blog on WordPress. If you need an uplifting (or even just a laugh) you should check it out at http://throwingsalt.wordpress.com/). It said:
God does not call the qualified. He qualifies the called.
Going into this, I was not well-equipped. At all. But I pressed forward, knowing that my Dude's will can never take me where His grace can not protect me.
GLORY!! I can't sit still....
If you need to reach me, call my cell.
Cuz I am about to walk outside in this parking lot so I have enough room to shout and give testimony!!!!!!!!
Towanna
Its such a peaceful Saturday morning here in the Met. I think that we are going to the zoo today, so I got up early to clean and do some laundry. But I hate that part of my life, so I take frequent breaks while I'm doing it. And I thought that maybe this would be a good time for my weekly blog entry.
There's a movie called "Life as House" about a man named George who has cancer and all sorts of other problems, who simply decides to build a house before he dies. He's divorced and has a teenage son with his ex-wife. The son is a drug addict who can't stand him and steals his Percocets to get high with his equally strung out girlfriend. So yaddah-yaddah-yaddah and blah-blah-blah, by the end of the movie, this huge dysfunctional group becomes a distorted picture of happiness and they all become a part of the construction of the house. The man dies, but his ex-wife and his son, in the traditional movie cliche', find the strength to move on and decide to finish the house for him.
Ok. So what's the point of all that you ask?
Well, there is a line at the end of the movie where George, the main character talks about change:
"You know the great thing, though, is that change can be so constant you don't even feel the difference until there is one. It can be so slow that you don't even notice that your life is better or worse, until it is. Or it can just blow you away, make you something different in an instant. It happened to me."
I think that I am going to have new business cards and t-shirts made up for our clinic with this as our mantra. The clinic staff and I started this journey back on April 11th of this year. I remember that first day, it was just me and KB, in one cramped room with no admin staff at all. We saw 17 patients that day. All of them new patients. I know that won't mean a lot to many of you reading this, but those of you who do know, will appreciate what kind of feat it really is to have see 17 brand new patients, using one exam room and no admin staff. We worked from 8 that morning until 8 that evening. And that went on for quite sometime before a new shelter director came in and offered us a larger space to work from.
I was under so much stress at that time, that I actually ended up with a flare of my TMJ, which I had not had a problem with since undergrad nursing school at MUSC.
We have to also remember that I had only been a nurse practitioner for 5 months when this all started. I was terrified enough at the thought of independently taking care of patients on my own, but at least in the regular office, I had several other providers at my immediate disposal should I need help. Out here at the clinic, it was just me. And if I had a concern about the care of a patient, a phone call was my only lifeline to the outside.
But looking back on it, as hard as getting those clinics up and running seemed to be at the time, I never flinched, never second-guessed what I was doing. Mainly because I knew in my heart, I had not chosen to be there. But I had been chosen to be there. On top of that, I knew that in the form of KB, God had sent me something that I had never had: a completely like-minded spirit with the same motivations, desires, and ego-absent work ethic that you need to endure what we were tasked to do.
Now, almost exactly 5 months to the day that we opened those clinic doors, I can tell you that I completely understand what George must of felt like as he noticed the transformation that his life had taken. Because we were so busy all the time, not only did I not notice the awesome evolution of the clinic while it was happening, but when I finally did take notice just a few days ago, I was completely blown away what it had become and even more flabbergasted by some of the changes I noticed in myself.
When I was going through NP school at Duke, one of my last rotations was with. Dr. S., an OB/GYN in Conway and an absolutely brilliant lady with high expectations for the people whom work with her. And sometimes, in my experience with her, that combination could translate into a milder form of tyranny. I went into that office with her everyday, always worried about getting my hand slapped. There were not many days that I didn't get my hand slapped and in my mind, that mean that I had an uphill battle getting to where I needed to be as far as she was concerned. But on the last day of my rotation, after seeing the last patient, Dr. S. gave me a great big hug....and offered me a job.
I did not realize it then, but her constant correction of me was her way of showing me that she knew my potential and she fully expected me to work to fulfill it. I always keep that experience with her in the back of my mind, because when I worked as a floor nurse at the hospital, I had some really nasty experiences with some of the doctors. The running joke amongst the nurses was to ask the question, "Are you a doctor because you're nasty? Or are you nasty because you're a doctor?"
I know now that its neither. At some point as a medical provider, you began to totally grasp what it means to work in a profession where there is little room for error. When you are in charge of the direction of ALL the work that goes into a patient's care, you tend to forget your manners and other people's feelings. Its always business. Never personal (although there is still a line of respect to be drawn). So as much as I used to get upset at those rude doctors who acted like I was bothering them when I called them about their patient, I never in a million years would ever think I'd understand where they were coming from. But I do.
Talk about blown away.
This all makes me think about a post from my cousin, JJ's, Facebook page a while back. (BTW, he has an awesome blog on WordPress. If you need an uplifting (or even just a laugh) you should check it out at http://throwingsalt.wordpress.com/). It said:
God does not call the qualified. He qualifies the called.
Going into this, I was not well-equipped. At all. But I pressed forward, knowing that my Dude's will can never take me where His grace can not protect me.
GLORY!! I can't sit still....
If you need to reach me, call my cell.
Cuz I am about to walk outside in this parking lot so I have enough room to shout and give testimony!!!!!!!!
Towanna
Wednesday, September 12, 2012
Fo-shingles, my ningles....
All Imma say is that you have to be careful about who you let doctor (or nurse) on ya these days.
Cuz there are some of us that have no idea what we are doing.
I'm not saying I'm the greatest. Not even close to it.
But there are some really fearless idiots practicing medicine out here right now.
I don't know anybody that is going to get it right 100% of the time. But there are some very basic things, in the course of a medical work-up, that even the most amateur of us, should not miss.
You know, like it might make sense that if a 60 year old man comes in with a stroke and elevated blood pressure, before you discharge him, you might want to check a few things to help me out if you expect me to be his primary care provider.
There's no reason why he was was in the hospital with you for 10 days and I had be the one to figure out that he's also diabetic and the reason that you couldn't get his blood pressure down in the hospital is because his kidneys are jacked up. Yeah. Cuz no one in the hospital had a decent enough stethoscope to have heard that massive aortic bruit during his belly exam. You did do a belly exam, right? (O_o)
And let's talk about shingles. Yes. Shingles.
Prior to graduation, I'd only seen a case of shingles once. And it was not even that bad a case.
So when this lady showed up at the clinic looking like the villain, Two Face, from the Batman movies it wasn't rocket science to know that it could only be one thing. That's right. Shingles.
Rule of Thumb: Shingles, derivative of the chicken pox virus, migrates along the pattern of dermatomes. Which means the rash will only appear on one side or the other.
It is viral. So technically there is no "cure," but only anti-viral medications can suppress the virus in the human body to hopefully keep it at bay.
So no, dear ER provider. Giving this lady Bactrim was not a good idea. Especially since she was allergic to it. Following it with Keflex and Benadryl was also not a good plan of care.
By the time she came to me, she looked like the aliens from that TV show "V." But just on the right side of her body.
Before I go, another piece of advice for the patients who might put too much faith in their provider.
If they give you a new medication, please make sure they tell you what it is for and what side effects might come with it use.
Because if you show up in my office with your lips looking botoxed and your eyes swollen shut and tell me that you didn't stop taking it because you "thought the medicine was supposed to do that," I can't have any sympathy for you. You just need to be glad that it didn't swell your airway and kill your crazy ass.
So, please. Don't walk into these medical offices thinking that everyone with a medical degree was a straight A student. Some of us only made it out by the skin of our teeth.
Be diligent. Find a provider you really trust and stick with them.
Towanna
Cuz there are some of us that have no idea what we are doing.
I'm not saying I'm the greatest. Not even close to it.
But there are some really fearless idiots practicing medicine out here right now.
I don't know anybody that is going to get it right 100% of the time. But there are some very basic things, in the course of a medical work-up, that even the most amateur of us, should not miss.
You know, like it might make sense that if a 60 year old man comes in with a stroke and elevated blood pressure, before you discharge him, you might want to check a few things to help me out if you expect me to be his primary care provider.
There's no reason why he was was in the hospital with you for 10 days and I had be the one to figure out that he's also diabetic and the reason that you couldn't get his blood pressure down in the hospital is because his kidneys are jacked up. Yeah. Cuz no one in the hospital had a decent enough stethoscope to have heard that massive aortic bruit during his belly exam. You did do a belly exam, right? (O_o)
And let's talk about shingles. Yes. Shingles.
Prior to graduation, I'd only seen a case of shingles once. And it was not even that bad a case.
So when this lady showed up at the clinic looking like the villain, Two Face, from the Batman movies it wasn't rocket science to know that it could only be one thing. That's right. Shingles.
Rule of Thumb: Shingles, derivative of the chicken pox virus, migrates along the pattern of dermatomes. Which means the rash will only appear on one side or the other.
It is viral. So technically there is no "cure," but only anti-viral medications can suppress the virus in the human body to hopefully keep it at bay.
So no, dear ER provider. Giving this lady Bactrim was not a good idea. Especially since she was allergic to it. Following it with Keflex and Benadryl was also not a good plan of care.
By the time she came to me, she looked like the aliens from that TV show "V." But just on the right side of her body.
Before I go, another piece of advice for the patients who might put too much faith in their provider.
If they give you a new medication, please make sure they tell you what it is for and what side effects might come with it use.
Because if you show up in my office with your lips looking botoxed and your eyes swollen shut and tell me that you didn't stop taking it because you "thought the medicine was supposed to do that," I can't have any sympathy for you. You just need to be glad that it didn't swell your airway and kill your crazy ass.
So, please. Don't walk into these medical offices thinking that everyone with a medical degree was a straight A student. Some of us only made it out by the skin of our teeth.
Be diligent. Find a provider you really trust and stick with them.
Towanna
Saturday, September 8, 2012
Don't Save Her...
Yeah, yeah, yeah. I know that it has been a while.
But I have a good excuse.
I almost died.
Ok, ok.
So maybe I didn't almost die. But that migraine that I told you about in the last post made me feel like I'd rather go home to glory.
Ok. Another exaggeration. (Dear Lord, it was just hyperbole).
But, I would have gladly swapped the pain from the migraine for that of giving birth to an almost 9 lb baby again. And I say church.
Preach.
Instead of trying to blog 2-3 times a week, I'm considering going to once a week. Probably every Saturday morning. Just sitting here right now, after not having posted in 10 days, reflection is easier. With the exception of love, shoes, and potato salad smothered in sweet barbecue sauce, they say that less is more. We'll see.
Anyway, I've never had a migraine that lasted that long. 5 days. And the pain was way different than what I usually feel. The dizziness, the nausea and the total insomnia just made it a million times worse. I think that I had been on auto-pilot for such a long time that I just did not pay attention to what my body was saying. You know? Stuff like, "I'm hungry." And "Close your eyes and take your stupid ass to sleep." With the schedule and pace of the clinic (like KB staying until well after 7:00 last night to make sure the patients got their meds or us seeing 13 patients a day with just one exam room), eating, sleeping, and toileting (I learned to hold my pee for 12 hours when I worked at the hospital) can sometimes take a back seat. And ordinarily, I'd tell you that ain't nobody got time for that anyway.
Ordinarily.
But when you find your already slightly insane self, hallucinating about being wrapped in a cotton candy cocoon, sealed into a goo-filled hyperbaric tank, put on a spaceship and kidnapped to the far reaches of outer space, to have your body probed by killer clowns with huge, shark-like teeth, while your Grandmother stands in the middle of the yard waving goodbye and saying, "Wha happen? I deef you know," because she can't hear your deafening shrieks for help, you begin to re-evaluate and make a permanent mental note of the things that you really don't have time for.
A near-psychotic break is now at the top of that list.
So I have committed myself to always make it a point to sit down and take at least 15 minutes to eat something during my lunch break and to get at least 6 straight hours of sleep at night. The eating thing should be easy. But I might need some, (ahem), intervention with that sleep thing when my brain's "pause" button (just like its "edit" button) doesn't always work like it should.
But I definitely want to avoid a repeat of last week's "A Dukie Down" situation. Especially because there is the potential, that instead of killer clowns, the next time it might be flashbacks of my aunt dressed like a deranged Cabbage Patch doll at the family reunion last weekend that might come back to haunt me.
And that is definitely some shit I won't like.
See there?
Edit button malfunction. (But the rest of y'all don't need to act like you weren't thinking the same thing).
But I digress.
For now.
Our undertaking to get these clinics up and running was ambitious to say the least. Its also what I signed up for, but my problem sometimes is that I am my harshest critic. I always feel like I need to do more, even when there might not be any more that can be done. Couple that with the fact that when it comes to the care of my patients, the Type A part of my otherwise easy personality takes over and I get tunnel vision. So if someone or something gets in the way, it/they probably need to be prepared to get run over. Its never personal and its not my habit to look back to check for survivors, but this time, I was forced to look back. When I did, it was my own reflection I saw in the rear view. With fresh tire tracks down my back and all.
But let's make sure that we don't get this twisted. I don't subscribe to the idea of the "living martyr" because that suggests that on some level, I would have to consider myself a victim and the set I rep doesn't turn out weaklings.
Justice League over here, my damies. (What up, Pootie?)
E.B White, the author of Charlotte's Web, said, " If the world were merely seductive, that would be easy. If it were merely challenging, that would be no problem. But I arise in the morning torn between the desire to save the world and a desire to savor the world. This makes it hard to plan the day."
Seriously.
The good thing is that since I began working as a nurse practitioner, I've never gotten out of bed just not wanting to go to work. Of course, there are days when I feel more up to the task than others. And most definitely, I hope that I will never ever have to unreasonably sacrifice any part of my role as a wife and a mother in order to fulfill my job responsibilities. As much as I love my job, that choice would be way too easy.
My prayer is only for balance. But I'm certain, that sometimes, just like me, even the most heroic among us secretly wish that our proverbial "ho" was willing to "turn tricks" for a more reasonable exchange. And we could just take a day off and go shoe shopping at Bob Ellis.
Obama-Biden 2012
Towanna
But I have a good excuse.
I almost died.
Ok, ok.
So maybe I didn't almost die. But that migraine that I told you about in the last post made me feel like I'd rather go home to glory.
Ok. Another exaggeration. (Dear Lord, it was just hyperbole).
But, I would have gladly swapped the pain from the migraine for that of giving birth to an almost 9 lb baby again. And I say church.
Preach.
Instead of trying to blog 2-3 times a week, I'm considering going to once a week. Probably every Saturday morning. Just sitting here right now, after not having posted in 10 days, reflection is easier. With the exception of love, shoes, and potato salad smothered in sweet barbecue sauce, they say that less is more. We'll see.
Anyway, I've never had a migraine that lasted that long. 5 days. And the pain was way different than what I usually feel. The dizziness, the nausea and the total insomnia just made it a million times worse. I think that I had been on auto-pilot for such a long time that I just did not pay attention to what my body was saying. You know? Stuff like, "I'm hungry." And "Close your eyes and take your stupid ass to sleep." With the schedule and pace of the clinic (like KB staying until well after 7:00 last night to make sure the patients got their meds or us seeing 13 patients a day with just one exam room), eating, sleeping, and toileting (I learned to hold my pee for 12 hours when I worked at the hospital) can sometimes take a back seat. And ordinarily, I'd tell you that ain't nobody got time for that anyway.
Ordinarily.
But when you find your already slightly insane self, hallucinating about being wrapped in a cotton candy cocoon, sealed into a goo-filled hyperbaric tank, put on a spaceship and kidnapped to the far reaches of outer space, to have your body probed by killer clowns with huge, shark-like teeth, while your Grandmother stands in the middle of the yard waving goodbye and saying, "Wha happen? I deef you know," because she can't hear your deafening shrieks for help, you begin to re-evaluate and make a permanent mental note of the things that you really don't have time for.
A near-psychotic break is now at the top of that list.
So I have committed myself to always make it a point to sit down and take at least 15 minutes to eat something during my lunch break and to get at least 6 straight hours of sleep at night. The eating thing should be easy. But I might need some, (ahem), intervention with that sleep thing when my brain's "pause" button (just like its "edit" button) doesn't always work like it should.
But I definitely want to avoid a repeat of last week's "A Dukie Down" situation. Especially because there is the potential, that instead of killer clowns, the next time it might be flashbacks of my aunt dressed like a deranged Cabbage Patch doll at the family reunion last weekend that might come back to haunt me.
And that is definitely some shit I won't like.
See there?
Edit button malfunction. (But the rest of y'all don't need to act like you weren't thinking the same thing).
But I digress.
For now.
Our undertaking to get these clinics up and running was ambitious to say the least. Its also what I signed up for, but my problem sometimes is that I am my harshest critic. I always feel like I need to do more, even when there might not be any more that can be done. Couple that with the fact that when it comes to the care of my patients, the Type A part of my otherwise easy personality takes over and I get tunnel vision. So if someone or something gets in the way, it/they probably need to be prepared to get run over. Its never personal and its not my habit to look back to check for survivors, but this time, I was forced to look back. When I did, it was my own reflection I saw in the rear view. With fresh tire tracks down my back and all.
But let's make sure that we don't get this twisted. I don't subscribe to the idea of the "living martyr" because that suggests that on some level, I would have to consider myself a victim and the set I rep doesn't turn out weaklings.
Justice League over here, my damies. (What up, Pootie?)
E.B White, the author of Charlotte's Web, said, " If the world were merely seductive, that would be easy. If it were merely challenging, that would be no problem. But I arise in the morning torn between the desire to save the world and a desire to savor the world. This makes it hard to plan the day."
Seriously.
The good thing is that since I began working as a nurse practitioner, I've never gotten out of bed just not wanting to go to work. Of course, there are days when I feel more up to the task than others. And most definitely, I hope that I will never ever have to unreasonably sacrifice any part of my role as a wife and a mother in order to fulfill my job responsibilities. As much as I love my job, that choice would be way too easy.
My prayer is only for balance. But I'm certain, that sometimes, just like me, even the most heroic among us secretly wish that our proverbial "ho" was willing to "turn tricks" for a more reasonable exchange. And we could just take a day off and go shoe shopping at Bob Ellis.
Obama-Biden 2012
Towanna
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