Wednesday, May 25, 2005


Help...I'm in pain & it's taught me a valuable lesson - raise the pt's bed up to a comfortable position for you when giving injections or doing anything.  I was giving one of my pt's an injection of Lovenox in the abdomen, I bent over slightly & heard "crackkkk."  I don't know what exactly I did, but it hurts.  I'm debating about whether to go see a doctor or chiropractor, or simply trying to rest so it feels better.  I'm ok when I'm sitting, ok when I'm walking - but going from sitting to walking is where I feel the most pain.  I probably need an adjustment, but I've never been to a chiropractor before & not sure I want to go.  I have had back pain like this in the past & I know it will heal eventually, but right now it seems like I'll never be the same (  Anyone need any tissues to cry for me???

Even with the pain, I did manage to get to my nephew's baseball game.  His team was in the state championship.  Unfortunately, they lost.....but he pitched so well.  He only allowed 2 hits the entire game.  It was the 2 pitchers before him that allowed 7 runs to be scored until he was called in.  I can't knock the other team though - Key West (who thought they'd be such a baseball powerhouse).  I read today that they have won 10 state championships & this was #11.  No wonder they were so good!  I have a feeling my nephew's team has a good chance at winning next year.  They are only losing 3 seniors & the seniors are not the strong ones on the team.  So we will see - maybe one day my nephew will make the pros! 

I had a wonderful week last week having some time off.  Got a little too much sun, but that's Florida for you.  I got to spend some time with my younger niece & nephew too.  Then it was back to work on Sunday.  I had 4 patients both nights...three out of the four were wonderful. 

My first patient was in with chest pain.  Turns out he had a heart attack in the past & he didn't even know it.  As a result, part of his heart muscle is destroyed & there isn't anything they can do other than manage it with medication.  So that's his game plan. 

My second patient came in with a BKA (below the knee amputation) that was done earlier this year & his diagnosis was sepsis.  By the time he became my patient, they had already went from a BKA to an AKA (above the knee amputation) to remove the infection that had set in.  I was very impressed with the surgeon, he did a good job.  I didn't see any signs or symptoms of infection & the patient wasn't in any pain. 

My third patient was a wonderful man.  It's weird how with some people you can instantly bond with & others it's like mixing oil & water.  He was an 84 yr old man that came in with chest pain.  While they were running tests on him, a chest x-ray revealed a mass in his right lung.  The doctor wanted to biopsy it, the patient didn't want to.  He didn't care if it was cancerous or not, he wasn't going to have chemo or radiation.  In fact, he already had signed DNR papers.  The pulmonologist asked me why wasn't the test done.  I told him "Because the patient refused."  He asked "Why did the patient refuse?"  Well, because he didn't want to have it done.  Isn't that the usual reason people refuse to have something done?  So he goes in there & somehow manages to talk the patient into having it done so that at least he'd know what he was dealing with.  If it were me & I were 84 yrs old, I'd rather not know.  This was a gentleman that still takes care of his wife who is in the early stage of Alzheimer's & is volatile towards him.  Perhaps his choices would be different if his home life were different, but he accepted that this is the way things are.  He had a good sense of humor & often said things to make me smile, even though he couldn't see very well.  I really liked his spirit.

He was sharing a room with my fourth patient - my confused guy.  I went in on Sunday night to do an assessment & asked him his name & if he could tell me where he was right now.  He knew his name perfectly, but he seemed to believe we were in the middle of the civil war.  So much so that he was fixing his uniform (hospital gown) in preparation for battle.  This patient was 88 & obviously he did not participate in the civil war.  WW II possibly, but who knows.  His admitting diagnosis was a small bowel obstruction & he had surgery to resolve that.  Again, the incision site was flawless - different surgeon this time, but still no signs or symptoms of infection.  It was open to air, had staples rather than sutures & looked about as well as an incision could look.  My hospital does have a couple of good reliable surgeons.  This patient was restless, I don't think he slept at all on Sunday night.  I had just finished charting around 5:15 Monday morning that he was confused, but made no attempts to get out of bed.  I jinxed myself - within 45 min, he had attempted to get out of bed & fell which resulted in pulling out his IV.  Thankfully that was the only injury & my co-workers jumped right in to help me out.  We ended up restraining him with wrist restraints.  I still don't like doing that, but he definitely showed me that for some people, it's the only way to keep them safe.  I had to fill out my first incident report.  :(  He was kept in restraints Monday night & he didn't like it one bit.  He even managed to get out of them one time & pulled out his other 2 IV's & chewed off his hospital ID bracelet.  He said he thought we were playing a game.   Huh???  I made sure the restraints were on better & he was unable to remove them on his own.  He was interesting, even offered me $50 to remove them, when I said no - he then said "How would you like to spend your last days on Earth tied up like this?"  So heartbreaking.  He couldn't understand that it was for his own safety. 

That was my week at work - I didn't make it in on Tuesday because of my back.  I may pick up Friday or Saturday to make up the hours - depends on how I'm feeling.  Right now it's not looking too good, but hopefully I'll wake up & be fine (yeah, right!).  One can hope, can't they???

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