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

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

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

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


 







 

I Will Survive....

Hey, Folks!!

I am home with the craziest migraine today. I get them from time to time. I can mostly muscle through them, but I've had this one for 3 days. Just sitting here looking at this computer screen makes my left eye feel like it wants to explode.

Definitely time for some intervention, so I am going to get a shot of Imitrex in a little bit. Its nice to be able to get seen at the doctor's office on a moment's notice. Membership does have its privileges.

Its funny how we get our inspiration sometimes.  I've been somewhat of an insomniac for the past few years, usually getting by on 4 - 6 hours sleep in a good night. That's 2 - 4 hours on a really bad night. Sleep has never really been a close friend of mine.

Part of managing my migraines is making sure I don't go without enough sleep for too long or it will catch up with me. And since I've probably only slept a total of 10 hours the last 3 nights, the severity of this migraine has come as no surprise to me.

But Sunday night when I found myself imitating a raccoon at 2 am, I started flipping through channels on the TV and landed on channel 72, which is the Oprah Winfrey Network. I was kind of geeked to see that "March of the Penguins" was about to come on. I guess if I was going to sacrifice a good night's sleep, watching these odd little birds and listening to Morgan Freeman's flawless narration was as good a reason as any.

It was the first time I'd seen it since it came out in the IMAX theaters in 2005. If you've never seen it you should. It is one of the most beautiful films I've ever watched. The plot revolves around the migration and mating rituals of penguins in Antartica. Their existence hinges on the thousand year old tradition and for reference, the animated movie "Happy Feet" is loosely based on the premise of "March of the Penguins."
 
After mating, the female penguins leave the mating grounds, with their eggs in the care of the male, to make the long hike back to the water's edge to gather food for their soon to be born chicks. That journey takes nearly 2 months, which means that the male penguins would go without food for that entire time. Many of the male penguins would not survive those two months and in turn, neither would their chicks. For the father penguins that did survive, if their chicks hatched before the females made it back with food, there was a good chance that they would die of hunger.

I was lying in bed, thinking that being a penguin might be the most awful thing to be in the world.  If I was a penguin, I'd pray that some adventurous human caught me in a net and sold me to the zoo. They could put me with a nice, civilized male penguin. Once my egg was laid, the nice zoo people could put it in a warm incubator until it was ready to hatch. See all that hiking back and forth in all that cold, dodging walruses, and scrounging for food when there is a good chance that in the end it might all be for nothing??? Stop playing. Ain't nobody got time for that.

As the scene of the female hike cuts to the mass of male penguins huddled together, plodding slowly about the mating ground, trying to shelter themselves and their unhatched babies from the bitter cold, Morgan Freeman's easy voice interrupted the silence.

"No matter how cold it is or how hungry they are, the fathers must keep moving. If they don't, they will die."

It's easy to forget that "survival" is a relative term.

What we consider necessary to survive is completely based on our own egocentric view of life and what we have gotten used to.

Same for penguins.

Same for my patients.

Last week, I saw a young, female patient who had been living on the street for years. She had been trying to get a bed at the shelter for some time, but she had to kick her drug habit before they would take her in.  She had been given temporary housing at a half-way house but said that she did not feel safe there. So she chose to live and sleep on the streets.

I asked her how she could feel safe sleeping in public bathrooms, in parks and at transit terminals, but not in a secured, supervised place.

She looked at me and said, "Yeah. The house I grew up in was supposed to be a secure, supervised place, too. I expect to find trouble in the streets."

That was lost on me until her case worker let me in on her history. She'd suffered multiple kinds of abuse at the hands of her stepfather, who had actually beaten her to within inches of her life at one point. Her mother would make the excuse to the schools that it was discipline for her rebellious nature. DSS had taken her away for a short time, only to send her back to have the cycle repeat itself. Broken jaw. Bruised lung. Forced abortion under the suspicion that the baby was her stepfather's. She finally left when she 17 and never looked back.

She was kind of like the penguins.

No matter how cold or hungry she got in those streets, she had to keep moving. Her survival depended on it.

On Friday afternoon, as I was leaving to go run an errand, she stopped me and told me that for the last few nights she had been sleeping on the sidewalk. She had used flattened cardboard boxes for padding and a trash bag for cover. She asked me if there was any way I could get a blanket for her.

I told her that I would see what I could do, but I had all intentions of telling her I asked around and could not find one when I came back.

But as I pulled back into the shelter parking lot and pressed my key fob to lock my car doors, I remembered that I had one of my daughter's blankets and pillows that she used for school naps and road trips in my trunk.
It took me a second to decide that I would let my patient have them, because it was my baby's pink velour blanket and her Disney Princess pillow, which I knew were her favorites. Having "favorites," though, meant that she had a variety to choose from.

Even in a matter of life and death, my patient, like the penguins, didn't have as many options.

So I popped my trunk, took out the blanket and pillow and walked back into the shelter courtyard where I saw the patient looking like she had waiting on me.

When she saw the blanket and pillow in my hands, a grin spread across her face and she ran and hugged me to the point that I was embarassed by the attention that it got from the other residents standing outside.

I told her that my child would be very upset if she knew I had given away her favorite blanket and pillow.

The patient apologized and said, "I'm sorry. I hope she's not too sad."

The truth is that it's ok.
She might be sad for a second.
But the important thing is that she'll survive.

Towanna

Jesus & Michael Jackson...and Star Wars

Good morning, All!!!

First, prayers go up to KB and her family as her Mom recovers from a recent heart attack. She is a living witness that what looks impossible to man is so easy for God.

2 Corinthians 5:17. That power right there can heal a broken spirit and the wounded flesh. Better get you some.

I got a call the other day about some health ministry business at the church back home. I am trying to decide how involved I am going to get into that situation at this point. Not because I don't want to get involved, but when I was fully involved, I experienced some of that church politickin' that I've heard so much about. Didn't like it. Not one little bit.

But don't get me started on that. This blog might get shut down.

Its cool, though. I finally realized that God has given me gifts that the people at home needed, but were not ready to accept from me. As much as I wanted to bring better things to my people at home, God had to move me out of that situation to show me that the work that He sent me here to do was not going to get done in that environment.  And I have been judged harshly for that.

The good thing is that harsh judgment is the proof that what I did was right. Otherwise, I'd be still pulling my hair out trying to please people who had already made up their minds that they were not going to be pleased. Especially not by me.

Chile. Boo.

God sent me here to save the world. I don't owe anyone an explanation of my purpose.

Plus, I don't know about you, but ain't nobody over here got time for that.

But I digress. Because only Jesus and Michael Jackson know what I mean.

I was talking to my supervising physician the other day about how I wanted to go into emergency medicine in my next life. That adrenaline rush is something else.

I told him how frustrated I get when a patient comes to me from the hospital or emergency room without complete care, like just enough was done to justify getting them out of there.

Its just seems like we need folks to change the culture of emergency medicine in this area. Especially for the poor and uninsured populations.

I have an elderly, male patient who is diabetic. He'd had a toe amputated a couple of weeks before the first time I say him. He said that he had seen the surgeon just a few days before that and had been released from care.  He had been being seen at a free clinic to have his diabetes managed. Obviously, though, the diabetes had not been under good control as witnessed by the fact that he had to have a toe amputated.

He was coming to see us to establish care and said that he was told by the surgeon to follow-up with a primary care provider for management of the amputation site. I took a complete health history that was only significant for a personal and familial history of diabetes. He had no history of drug, tobacco, or alcohol use. His blood pressure was excellent and his weight was appropriate for his height.

But when I asked him about his medications we hit a bump in the road.

He was wearing an old-school fanny pack. He unzipped it and started pulling out insulin pen after insulin pen after half-empty insulin pen. Lantus. Novolog. Regular and 70/30. Humalog. Levemir.

"Which ones are you supposed to be using?" I asked him.

His reply: "What's the difference?"

Among other things, he told me that he was using the insulin 3 times a day after meals and wasn't really sure what combinations of insulin he was using. What he did tell me was that he usually gave himself  2 - 6 units each time depending on what he ate and that he did not have a meter to check his blood sugar.

His finger stick blood sugar and rapid A1C in the office that day was 174 fasting and >13.0 respectively.We drew a complete metabolic panel to check his kidney and liver function and a lipid panel to assess his cholesterol.

His physical exam was essentially normal.

That is until we got to his feet.

Now I am no surgeon, but I was pretty sure that releasing this man from his care was probably not a good idea.

Where the "pinky" toe of the right foot had been was a open wound, oozing green and yellow pus with a gangrenous flap of skin hanging off. The other four toes were all blistering, bleeding, or oozing pus in some combination. It was obvious that he was going to have to lose at least part of that right foot. The left foot was in better shape, but not by much. If he did not have some intervention immediately, it would suffer the same fate as the right one.

 As I stood there examining his wounds, it suddenly hit me that he had not made a sound the entire time...because he had absolutely no feeling his feet at this point. The out of control diabetes had completely compromised his circulation.  There was no telling how long he had been walking around like that.

We were able to get in touch with the surgeon's office. It was Friday and he had left early, but I did speak to his nurse who gave me an appointment for first thing Monday morning. I told here that I would clean and dress his wounds and put him back on some antibiotics until then.

As I suspected, the surgeon decided to amputate his forefoot. The surgery was scheduled for Wednesday morning. I fully expected that we would not see him back at the shelter until at least late Thursday or Friday morning.

But I should have known better.

That same Wednesday afternoon, one of the shelter's staff came to the clinic area and asked KB and I if we had time to come check on a patient that was bleeding in the day room.

We followed him through the double doors to the day room and our eyes settled on a heavy trail of blood leading to a table near the front desk. When we finally spotted the source of the bloody scene, I realized it was my patient. He'd had his foot amputated that morning and was discharged back to the shelter just hours later.  The patient's story was that he stayed in recovery for about 2 hours before he was discharged. He had walked back to the shelter from the hospital.

No wheelchair. No crutches. Just a gauze dressing and a blue "shoe" with velcro straps.

His leg was propped up on a chair and underneath the chair was a widening pool of blood. His once white bandages were completely red and blood was actively pouring from the wound. The patient was sitting there like nothing had happened and I was actually grateful for the fact that he could not feel anything. I asked the shelter staff to call 911 because there was no way I would be able to stop that bleeding. KB and I gloved up and began to wrap his foot with layer upon layer of gauze. It only took the ambulance a few minutes to get to us, but by the time they did, there was a red spot growing on the wad of gauze we had just put in place.

Not long after the ambulance picked him up, he was back at the shelter. Apparently, on the walk back to the shelter, he'd busted open his stitches. At least this time, the hospital had given him a cab token for the ride back.

I saw him back a few days later. He'd been set up to be seen at a foot clinic for follow-up. We got him a new meter, ordered him some diabetic shoes and started him on Metformin, Lantus and 2.5 mg of Lisinopril for kidney prophylaxis. I thought about adding mealtime insulin, but felt that it would just complicate things for him at that point.

Plus, and I don't know if this can really be described as a good thing, but the good thing about many diabetic homeless patients is that most of the time, they have not been taking their medicine correctly, if at all. That means that even if their A1C is off the chart, there is great potential that you will have a marked improvement in the control of their blood sugar within the first few months of consistent therapy.

All of this happened a couple of months ago.  I've seen the patient back a couple of times. KB and I have taken a lot of time educating him on his diabetes and his treatment regimen. In the process of all this, we found out that he only has a 3rd grade education and can barely read.

He also told us that he actually had a meter at one time, but that he did not know how to use it. No one ever offered to show him how to use it, so he just didn't. We made sure that we got him a one touch meter with visual prompts to make it easier for him.

Sometimes, it just takes us to recognize that a patient's failure to take care of themselves may be based upon our failure to give them all the tools they need to do so. The patient-provider relationship is meant to be both altruistic and symbiotic. Responsibility for success and failure must be equally shared.

That patient is doing very well these days. He came into the clinic for labs earlier this week was ecstatic to show us his blood sugar diary. His fasting that morning was 96. I can't wait to see what his A1C looks like.

I am proud of and excited about the work that we do in the community. AF and HL are doing a great job at planning health education program planning for the residents at the shelter. We have our diabetes class coming up here soon and the turnout should be massive.

My work has got me giddy. Like a Star Wars geek at a Sci-Fi convention.

Towanna

Love & Help Us Columbia

Good Day, Folks!

Did you miss me?

I know you did.

The last 7 days of my life have been so hectic. I am just getting a minute to take a breath. But that is what I love about the road I'm traveling right now. Never a dull moment. Change is constant. Adaptation is a must.

And that's adaptation. Not assimilation.

But there are a few constants in my life that I know I can always count on: God, my family....and drug seekers.

In that order.

Clinic gets busier every day. The busier it gets, the higher it seems some of the patient's want to ramp up their craziness.

I had a female patient who we banned from even stepping foot into the clinic area because every time we saw her she seemed to be looking for a confrontation. Her story was that she broke her wrist 15 years ago and wanted me to give her Percocet, which is a schedule 2 drug that I can't prescribe anyway. I refused her because when I checked her in the SCRIPTS database she was getting narcotics from several sources --- including a doctor in Charlotte who she was traveling back and forth to see. If she was smart, she would have filled the script in North Carolina and then it would not have shown up in SCRIPTS because it only covers South Carolina controlled substances.

We got a report back from an orthopedic surgeon who saw her in consultation that said when he refused to give her pain medication, she requested that he amputate her hand.

Talk about cutting off your nose to spite your face.

But she showed up on Friday and asked us to check her blood sugar. "No" was on the tip of my tongue, but KB, blessed spirit that she is, told her yes and asked her to sign in and have a seat in the waiting room.

Now this was around 3 pm. We were still seeing our regularly, scheduled patients and I was about to start a well-woman exam so she was going to be waiting for a few minutes.

I think 30 seconds passed before she walked back in screaming that we were "playing with [her] life." KB was in the room working up a patient, so I took a deep breath and tried to explain to her that we would be with her shortly, but that she walked in while we were really busy and she just needed to be patient for a few more minutes.

But the more I tried to reason with her, the louder she got. So I got loud, too.

And you can ask my sweet siblings, KB, or my cousin's wife, Keisha, but when I get loud, you might as well shut your operations down for a moment. I'm not going to stop until I know you've heard me.

So I (loudly) explained to her that she had been banned from the clinic for her prior behavior and that we were only seeing her as a courtesy. Not an obligation. I told her to leave or I would call security to remove her.

As I walked towards her, she started to back her way out of the door.

"I'm going to a higher authority to report you."

I thought to myself, "And??? You aren't the first and you won't be the last. What else?"

Then she played her trump card.

"I know you and the rest of these people smoke crack. You old crackhead m*****f*****!"

Now this caught me off guard. I've been called a lot of things in my life.

But never a "crackhead mofo". She get's major props for that one.

I wish all the irate patients had such original thoughts. I can only be called a "b-word" so many times before I get completely bored with it.

The really frustrating thing about this woman is that even after we banned her from our clinic, I made arrangements for her to see a provider at another site. And she behaved in the same way with him and now he has refused to see her.

More frustrating than that is that this lady really has some serious health problems including diabetes, high blood pressure and lung disease. But she never gave me a chance to help her with what I really needed to help her with because she is blinded by her addiction to those pain killers.

I'd like to manage her diabetes, get her blood pressure under control, help her to quit smoking and try to keep her out of the hospital for her frequent COPD flares.

But regardless of your race, religion or socio-economic status:
Help only helps those that help themselves.
And love don't love nobody that don't love themselves.

Be good, y'all.

Towanna