Sick puppy dog

After working last night, I came home to find my dog not feeling too well.  I don't know if he has some dog flu or if it's old age setting in.  He's 12 years old.  My dilemma for the past couple of years with him is...when do you know it's time to say good-bye?  He's been sleeping on my bed all day & night...not hungry at all.  His nose is really warm as well as the bottom of his paws - I know that means he is sick or running a temperature or something.   I have no idea what to do for him.  On top of that, arthritis is setting in & he's having a difficulty walking.  However, he is still very alert (while awake) & with it mentally.  So how do you know when it's the right time to make that decision to say good-bye?  I've had him since he was 5 or 6 weeks old & just thinking of losing him makes me cry.  He's been with me the majority of my adult years...my baby so to speak.  Through all the good times & the bad times, he's been the one constant in my life.  He's there day in & day out.  Ugh, I don't like thinking about this stuff.  ;(

I had a good night at work.  One patient was a 67 yr old female in with a COPD exacerbation.  She was upped to a 50% venti mask & that caused her to have numerous nose bleeds.  On top of that, her heart rate would climb to 130-140 for no real reason & then go back down again.  I ended up calling her doctor around 3 am to make him aware of her heart rate & nose bleeds.  His reply "That's fine."  I asked "You don't want to do anything about her heart rate?"  His reply "No, that's fine.  I'll see her in the morning."  Ugh, I hate replies like that.  She was a sweetheart - kept praising me (who wouldn't like that).  She wanted to speak to my supervisor to let her know how wonderful I am.  I ended up getting her some "Share" cards.  It's basically a card you fill out when you want to compliment someone.  It is nice to be appreciated. 

My other 3 patients were men.  One had a stroke & was so utterly confused.  You couldn't even talk any sense into him.  So I stood there & listened to him & each time I told him I had to get back to work, he'd start to cry.  So I'd stand there a little longer while he repeated everything going through his mind & then he'd start to cry again.  I felt for him, but there was nothing I could do.  Well, except to give him a sleeping pill.  Some people might not agree with that, but this gentleman would not have gotten any sleep without medical intervention.  His mind had been racing - kept telling me he had to get TO the hospital.  I'd tell him "Sir, you are at the hospital right now."  He couldn't comprehend that. 

My next patient had a cardiac cath done earlier in the day & they found his circumflex was 80% blocked = transfer him to a different hospital for cardiac intervention.  I had to arrange his transfer.  He was also confused.  Coming on to shift, I found him wandering in the hall.  I took him back to his room, reoriented him...he was ok.  Later in the night...like 4 am, again he was wandering in the hall & eating a banana.  Where he got it from?  I don't know.  He was saying he was on a boat & could feel the waves moving below him.  Ummm, ok.....back to bed.  This time I put on the bed alarm so we'd all be aware if he were to get out of bed again.   EVAC showed up a couple of hours later & the transfer was made.

My last patient was a 79 yr old gentleman with the diagnosis chest pain R/O MI.  I don't think it was an appropriate diagnosis as the man had no chest pain at all - not even prior to coming into the ER.  He hadn't been feeling well & felt like he was having trouble breathing so he went to his VA clinic.  They in turn gave him a prescription for nitroglycerin tablets & sent him to another clinic to get a chest x-ray.  He went to the other clinic - they couldn't get him in until the afternoon - so they sent him home.  Nice - the man is having trouble breathing & they send him home.  On his way home, he fills the prescription & takes 3 nitro tablets when he gets home.  I don't think he had any clue how nitro works.  Needless to say, his blood pressure bottomed out & he was having syncopal episodes, so he called 911.  This gentleman is 79 yrs old & still works as a barber.  Not so much because he wants to, but because he has to in order to pay his bills.  Sad....79 yr olds should not "have to" work. 

It was an easy night.  The time did fly by, I am still tired & heading to bed after watching Nip/Tuck.  That show is so bizarre, but I can't stop watching it.  I'm off now for 2 weeks.....I have a feeling it will fly by.  I have some decisions to make regarding my puppy dog.  :(  Right now I think I'll just cuddle with him & hope he's feeling better in the morning.