Icky
I have a very, very good friend. I'll call her crazynurse. She was a nurse to crazy people, is not herself significantly crazy, although she is quirky.
Anyway, crazynurse is the reason I ended up working at the nuthouse. She got forced out by them several years ago, shortly after she had double knee replacement surgery. She's a good person, and a very good friend.
She just turned 65. I was at her home for a huge surprise party her daughters threw for her.
She has had mobility problems for years, and the knee replacement didn't help very much. Just as she was healing from the knee replacements (this was after the nuthouse fired her), she had a bloodclot in her leg. She was treated with blood thinners, but the hospital where she was didn't manage her dosing properly, and she leaked blood into one leg, causing nerve damage before the doctors figured out what was going on. So, her mobility problems got worse, although she was getting around with a cane okay.
Alright, so then her kidney function declined more rapidly than expected. she has been on dialysis the last couple of years.
Oh, did I mention that she is extremely overweight and had non-insulin dependent diabetes? I don't know what she weighs, although she often claims that she has lost weight ... quite honestly, I've never noticed it. (as an aside, overweight people suck at estimating other people's weight. She could be anywhere between 250 and 400 pounds for all I know)
So, that's the background.
Last week I find out that she's been having some wound healing issues ... ulcers on her legs, and something about an open sore on her heel.
Foot wounds and diabetes are not good. Really not good. Little did I know that it had bypassed really not good and headed straight into scary not good territory.
I get a call from her on Saturday night. If I weren't already out at someone's house (and without my car), I would have been over at her place in a shot.
youngerdaughter (who is now over 30, I've known the kid since she was still in diapers) got rushed to the ER from work on Saturday because she was hemmorhaging vaginally. Near as I can figure, what she was doing was having an extremely heavy period, but what do I know?
Anyway, crazynurse, being a good mom, heads on over to the ER.
She told me that as she was in the driveway just about to go into the ER, she heard a "popping noise," was unable to support herself, and fell.
She was unable to get up. This is not a recent issue. For as long as I've known her she's not been able to rise from the ground ... I was with her once when she slipped on ice, and it required several neighbors and both of her kids and their boyfriends to get her back to standing. Anyway, a passer-by got help for her and she was taken into the ER.
This is where I first learn of the extent of the wound. Apparently this "little open wound" has exposed her Achille's tendon. As if that's not icky enough, it's draining constantly and is foul smelling (drainage can be moderately okay, but foul-smelling is definitely bad). The ER doc redressed her wound (or rather had someone else do it), did no studies or radiology, and sent her home. supposedly the tendon was intact. I say supposedly mainly because, although improving, the hospital in question is not known for astute and accurate diagnoses.
I arranged to go over to her house yesterday, and since it's summer and too hot for chicken soup, I took ... Ricotta White Eggplant Pizza (from Via Veneto, in case you were wondering UT).
In addition to being able to spend time with her and be supportive, I was going to do the things her daughters should be doing for her ... both of them and their husbands live with her, but aren't always terribly good about helping her. olderdaughter has a crazy idea about moving to Saint Louis (no job, no prospects of one, doesn't know anyone there), and is there right now. 10 yard penalty for her of not immediately cutting her trip short and returning home on learning what happened to crazynurse. She's not expected home until late this week. youngerdaughter, despite being in the house, is resistant to doing anything for crazynurse. I was there to help crazynurse with showering, for example. At least youngerdaughter did take care of the icky bits ... the dressing change on the wound.
So, the wound.
It's all kinds of awful.
This "little" wound is actually about 2 cm x 3 cm, and you can see the exposed tendon and the fat layer and other medical stuff I can't identify. there's some shit hanging out of the wound that I'm pretty sure should be attached more firmly to something else (which is why I worry about the tendon). And it does smell to high heaven. crazynurse has been going to a wound center, but I'm doubtful that they've been sufficiently aggressive about treating it. She was supposed to approach her dialysis team about it today and was going to try to get an emergency appointment at the wound center.
I have cellphone pictures, but the focus is poor, and they are really, really icky, so I'm not going to inflict them on you.
I am fearful that things are probably close to the point where crazynurse is looking at an amputation. It's more than just the bigass hole ... she has ulcers on the front of her lower calves, although those do seem to be resolving, and the overall quality of the skin of her lower legs is really, really poor. It's not healthy-looking or pink. Dry, scaly, and grayish brown is not generally what lower legs look like. On a living person.
I am going to check in with her this afternoon and give her the name of the best diabetic wound care guy in the area. I got his name from my friend, tatadoc.
Geez - so sorry to hear that. I hope that they get this all sorted out.
oh ugh. Banana Lady has diabetes and is not overly sylph-like. She seems to trip/fall rather too regularly and the wounds she gets from seemingly simple scrapes can be atrocious. She's here now, just finished recoving from the last fall (a long time ago) so we're trying to get a new exercise regime/weighloss program started and ingrained before she goes back. Took her for a birthday Pedi today because she said she wished her toenails were pretty like everyone at the pool. I think she enjoyed it and her feet and lower legs look much better for it.
Best wishes for your friend and thank goodness she has you.
That does sound pretty nasty. I hope they get to it in time.
monster, you have a brave pedicurist. Most of them won't touch someone with diabetes because of the risk of infection and wound healing issues. However, diabetics can get a pedi from their podiatrist, and insurance will pay for it ... although I don't think he will let you choose petal pink!
I will be taking her to an appointment for a vascular study of her lower extremities on Thursday. youngerdaughter and olderdaughter are not doing this. I do not know why.
I dunno about that wolf. My wife gets pedis all the time and she has lifelong Type II diabetes. And ingrown toenails. And sensitive feet. It takes her a while to find an acceptable pedicurist but once she does, she clings to them like a monkey on a vine. I have never heard of her getting rejected due to her diabetes.
not the case, we found, wolf.
1) they do not care. But Banana lady watched her like a hawk because she cares. They did not ask anything, were not concerned when BL told them be careful with the clippers because she was diabetic. They just want the business.
2) Visitor from UK = no insurance. In the UK she does get free "pedicures", but they're medical ones, not fun ones. No massage and no polish, just a clip and grate.
...and I gotta say, that's the best $30 I ever spent! She's gone from nasty feet she's ashamed of to showing off her tootsies at the pool to all the other Pedi fans and non-fans alike. Anyone, in fact! She's loving it.
...I even think it might have made her more aware of her feet -she seemed to be walking better this evening..... could be wishful thinking, though....
...but they're medical ones, not fun ones. No massage and no polish, just a clip and grate.
So, no Happy Ending, then?
She needs to get that thing debrided, a wound vac on it, and hyperbaric treatment if possible. From the sounds of it, without seeing the pictures, it is stage III or IV and she is very likely to lose the foot, if not undergo a whole BKA. That thing is a MRSA, sepsis, or gangrene infection waiting to happen, which could easily kill her. Many of my patients at the private EMS company have such wounds, and they need regular, specific attention in order to ever heal up.
Do you have an update, wolf?
I think I have her convinced to see a wound care specialist. We go tomorrow morning for a vascular study.
What I didn't know was this thing went from a small blister to the monstrous wound I saw in the space of less than a week.
She says they tested her for MRSA and claims that all the tests came back clean.
Yeah, right. Little bitty kittens are cozying up to her every night and eating her flesh. Of course it's fucking staph or something.
tatadoc isn't sure if she'll be able to "dive" given her weight. I already asked my friend if they suggested a wound vac and she said, " a what?"
Send her this ...
[YOUTUBE]SDprRTHw4I0[/YOUTUBE]
tatadoc isn't sure if she'll be able to "dive" given her weight. I already asked my friend if they suggested a wound vac and she said, " a what?"
huh? I'm missing something here. "dive"?
dive is reference to a trip to the hyperbaric oxygen treatment chamber.
My brother had wound vac treatments when he was injured last May. They helped his wounds heal a lot faster than they would have normally. (Long story that...accident during a training exercise at Ft. Bragg). Highly recommend the treatment if insurance covers it. Apparently the sponges that are used for the treatments are hella expensive.
thanks wolf. I hope she gets fixed up soon.
Apparently the sponges that are used for the treatments are hella expensive.
I don't know why, they're basically just sterile audio foam... oh wait, audio foam is hella expensive too.
So, this past Monday, crazynurse was supposed to go directly from dialysis to wound care, because it was really gross looking, necrotic tissue and all that.
Purulent discharge is a bad thing.
So, of course she didn't. Despite having this mess seen by an ER physician on Saturday, who was clearly an idiot who skipped Anatomy class, the dialysis doc on Monday says something on the order of, "Well, you're scheduled to see wound care on Wednesday," and she accepts this statement and goes home.
Her daughter tells me that she gags when she does the dressing changes.
Living things don't smell like that.
So ...
Wednesday afternoon I get a panicky call from her, from dialysis. She says, "wow, this thing is worse. I'm going up to wound care."
Waitaminnit ... didn't you go up to wound care on Monday?
No.
Okay, then. You sound like you need some support, I'll scoot right on over to the hospital.
Then she decides that I should just go straight to the house.
Against my better judgment I do, only to learn that my housekey no longer works ... apparently they changed the locks sometime in the last 25 years (I'm told, btw, that my key probably still fits the basement door, but I haven't bothered to try it).
And so ... since it's stinkin' hot, I drive over to the hospital.
And get to wound care just as they're peeling the gauze off her.
REALLY stenchy. Worse.
The doctor there is snipping bits here and bits there, and dabbing at some of the ooze.
He doesn't seem concerned.
crazynurse at one point mentions that she wants to maybe go to the emergency room, or see the parent hospital's wound care center. (We're doing all of this at Abington-Lansdale, formerly Central Montgomery Medical Center, formerly North Penn Hospital. If you know the area you know ... YOU DON'T GO TO THIS HOSPITAL UNLESS YOU'RE UNCONSCIOUS AND DON'T HAVE A CHOICE. Now that they're under new management, things are getting better, but it's in stages, not all at once.
What does the doctor say to this perfectly reasonable statement about wanting to manage one's care more aggressively? "Why would you want to do that?"
I get crazynurse home. She tries to make contact with the specialist tatadoc recommended. He's out of the office, and is in surgery all day Thursday, but his receptionist tells crazynurse to call the Abington Wound Care Center.
I've had contact with these folks. They are AWESOME. momwolf went there after her abdominal surgery.
So, of course they're closed, but crazynurse leaves messages and will call again Thursday morning to try to secure an appointment, otherwise, we're heading for the good ER, at Abington Memorial Hospital.
Next morning comes, I'm over at crazynurse's house with Egg McMuffins and apple juice (she can no longer mount the one step into her kitchen and can't feed herself, and her offspring aren't doing anything to help her. She has already made the call to Wound Care and they've given her an emergency appointment.
Load her and her wheelchair in her car (as big as my car is I can't get a wheelchair in the trunk even when it's empty) and off we go. Other than an argument about the best way to get to the Wound Care Center. I reminded her that 1. I've been there before and 2. If I go her way I add about 5 miles and at least 20 minutes to the drive with the traffic and lights and stuff, and we're already going to be late.
So ... we get there, and the staff are as awesome as I remember.
The wound care nurse, who sees a lot of bad stuff, recoils from the smell, and gently says, "I think you should start mentally preparing yourself for the possibility that you may need to go to the hospital."
Told her ... yeah, way ahead of you on that one, crazynurse packed a bag.
The surgeon came in, glanced at the wound, asked why crazynurse let this get so far ... politely told him "because the other doctor is a gaping moron and she listened to him."
"You're being admitted to the hospital. I'll do surgery tomorrow to see what we can do to preserve the limb."
So, he takes charge, he's fast, and proactive. I'm digging him.
Less than 45 minutes later, including the drive over and processing all the paperwork, she's in a bed.
Abington Memorial Hospital, incidentally, has grown quite a bit since I was there as a teenager. The original hospital is now called The Elkins Building and there are multiple buildings on the campus, including two parking garages. Not to shabby for a suburban hospital.
Surgery was yesterday afternoon. I didn't get to see her beforehand because they took her to preop straight from dialysis.
So, I waited.
The surgeon came out to see me before he started ... didn't seem to be common practice, there weren't a lot of docs coming out and talking to families ... information is passed through a dude at the desk in the waiting area.
Doc also called me at the conclusion of the procedure, in which he cleaned out a lot of infected tissue. The bad part: Her achilles tendon was ruptured AND infected (shame on you, ER doc who said, "there's no damage to your tendon"). It's unclear at this point how severe her disability will be. The good part: The infection has not gone into the bone.
Finally, her daughters show up ... around 6:30p. Surgery had been scheduled for 3.
Okay, my family is different, but you show up for shit like that. Without question, and without pause.
And they were going to leave before she was out of recovery, but we finally got word that she was headed up to her room, so crazynurse at least got to see her grandchildren (one of whom went to some teen youth group outing instead of coming to see mom-mom).
I hung around a bit after they got crazynurse back into bed. She was awake, alert, and doing pretty well, all things considered.
As a bonus, I overstayed visiting hours and didn't have to pay for parking. I did, however, find out that it's the same cost to self-park as it is to use the valet service.
A word about the family waiting area ...
I've been in a LOT of family waiting rooms.
Usually you get a couple uncomfortable chairs in a small windowless room, have to wander around half the hospital to find a bathroom, and get limited information.
Not at Abington Memorial Hospital.
The room is large and spacious.
It's in a six story atrium, open all the way to the skylights at the top.
And there's a tranquility fountain.
Usually this means a small to moderately sized bowl of water that makes a trickly noise.
This thing is the height of the floor below the waiting area, and about twenty feet wide, so it gives extra tranquility.
The photo really doesn't give the proper sense of the immenseness of the space. The family waiting area is that first level up from the fountain.
Good on you Wolf. You're a great friend.
"because the other doctor is a gaping moron and she listened to him."
:headshake This happens so much more often than people think. She's lucky to have you, wolf. Keep up the good work.
Four out of five doctors think the fifth doctor is an idiot.
85% of.....
wolf. you rock. thank goodness you're there for her.
Maybe there are reasons we have so many malpractice suits... like awful doctors. She is so lucky to have you as her advocate. That level of incompetence is shocking. Something is very broken when people like that are allowed to practice.
Wow that is some grade-a scary shit! My dad has been diabetic for years but completely in denial about it. He's finally supposedly doing something about it (he's said that before), I'm thinking about making him read this thread. He also gets frequently wounded with his handy-man do-it yourself take to home repair and his job as a fireplace technician.
You're friend is very lucky to have you and I'm glad to know my 'rents would never be in the same situation with us kids. My sis would definitely take care of them. :P
Wolf, your friend is definitely lucky to have you by her side. I hope she's doing better.
As of last night she has a wound vac, infectious disease is trying to come up with a cocktail of antibiotics and antifungals that will be effective, and I haven't heard anything about how the cultures have come back in terms of exactly what it is that's been eating away at her insides.
I am hoping that my friend heard wrong when someone mentioned discharge as early as tomorrow.
Since she definitely heard wrong that she was permitted to be weight-bearing on her injured leg, there is a good possibility of this.
Last night her mother was on the phone begging me to be there at the hospital when the social worker met with crazynurse. I suggested as politely as possible that either the daughter who will continue to live with her should be doing that, or maybe the sister who is a nurse practitioner ...
What a nightmare, Wolf! Your friend is very lucky to have you. Maybe there is a silver lining of sorts to you being unemployed at the moment? I bet you couldn't spend so much time with her if you were still working your regular job.
I certainly hope she doesn't lose her leg. I had a friend whose dad was diabetic, and the docs had to keep cutting off first his foot, then his leg at the knee and then finally at the thigh. Diabetes sucks. Getting old sucks. ER doc's all too often suck. I have had enough experience with them both personally and with friends that I don't trust them one bit. Thirty years ago, I was in a major accident and the ER doc on call picked that particular night to get drunk on his ass. I was in bad shape to begin with and he almost finished me off. He later TEMPORARILY lost his license due to his alcohol and drug abuse. Then the hospital or the AMA or somebody gave him his license to practice back. He proceeded to actually kill a patient while drunk. I guess I was lucky, but I still have health problems to this day due to what Dr. "It's 5:00 Somewhere" did to me. :greenface
You and your friend are in my thoughts.
What a nightmare, Wolf! Your friend is very lucky to have you. Maybe there is a silver lining of sorts to you being unemployed at the moment? I bet you couldn't spend so much time with her if you were still working your regular job.
Couldn't have said it any better myself.
Actually,
I just did.
Sorry to hear about your experience with Doctor Drunk&Stupid. shame on his cow orkers for not diming his ass out.
I have actually done this ... had a shrink come in drunk for night call. Had to call the medical director and find a diplomatic way of asking her to blow into the little tube.
There are a lot of really good ER docs out there, some of whom have chosen to specialize in emergency medicine because they actually like it. But you also get a lot of jackasses who are just looking for the money and are hoping for a slow shift in which to make it.
A social worker met with crazynurse yesterday, because they are starting to look at options for discharge ... not home, but to an extended care facility, which is the polite way of saying "nursing home," which is a polite way of saying "warehouse for the dying" in a lot of cases.
We've got several people working on trying to ascertain, as best as is humanly possible and then some, that the facilities they're offering are not vile pits of suffering.
She already knew enough to reject two of them out of hand.
There are a couple of complications that are limiting the choice of an agency. The first is that she remains on a wound vac, and not a lot of nursing homes take patients with them. She is also non-weight bearing on that leg, and therefore essentially non-ambulatory.
And then there's that she's not sylph-like ... she's short, but her BMI is over 50.
And there's the dialysis.
There seems to be one nursing home with on-site dialysis services, but it falls in the category of vile pit of suffering.
The leading candidate on offer has good surveys ... in their last three state licensing surveys they had two with no deficiences, and one in which they were cited for having offered a straw to a patient who wasn't allowed a straw, and for two instances of staff not having had their TB tests. A re-survey showed that these deficiencies have been addressed and corrected.
In practical terms this means that facility's paperwork is
pristine.
They could still suck, but their documentation is excellent.
One of the problems that I have is remembering what the place used to be called. Nursing homes change names faster than porn stars, so while the current name isn't doing anything for me, the old one may make me go, "ooooh, no."
We are being limited by geography on the choice ... there are several good facilities we know of, but they are out of the service area for the good hospital, and, in fact, would be in the service area of the hospital that screwed up my friend on more than one occasion ... this current event, as well as mismanaging some medication doses while she was inpatient seven or so years ago that lead to severe nerve damage and caused her mobility problem.
So, we continue to wait and see.
Best of luck to you and your friend. I have helped a few people look for an extended care facility for their kids. The problem is the same but different. Special needs for coma or minimally conscious patients require special nurses and equipment. Basically, there are none. The term you used "warehouse for the dying" is far too appropriate. :(
I know a GREAT vent facility, if any of your contacts need one ...
So how do you find an assisted living place that's good? We're looking for a place for my father in law, and called basically a referral service who told us about area places in our price range. So we toured half a dozen, and got impressions from that. But the tours didn't take us to every floor of every place. Some of the tour guides were greeting all the patients by first name as we went around, in other places, they clearly didn't know any of the patients and the places just seemed depressing.
But is there some agency or other entity that can give an unbiased assessment of these places? I wish I had some connections around here in health care who could give me some insider tips.
The tour is a big part of the decision making process. If the agency won't tour, don't take them.
And when you do tour, you're looking for some specific things ... does the place smell like pee, do the residents look well cared for, and, if you're looking for a specialty service, make sure they take you to that area while treatment is going on, Physical rehab, for example.
And you might want to show up around lunchtime ... you'll see what they're serving the residents in the dining hall, and may even be able to get a taste test.
Best secondary sources of information: the ambulance squad that serves that nursing home for emergency calls. Also, if you have any friends who are primary care physicians, they might know about the agencies, and may do coverage hours there.
that's helpful. It also made me thing to look up the state social services website and they had some info too.
So how do you find an assisted living place that's good? We're looking for a place for my father in law, and called basically a referral service who told us about area places in our price range. So we toured half a dozen, and got impressions from that. But the tours didn't take us to every floor of every place. Some of the tour guides were greeting all the patients by first name as we went around, in other places, they clearly didn't know any of the patients and the places just seemed depressing.
But is there some agency or other entity that can give an unbiased assessment of these places? I wish I had some connections around here in health care who could give me some insider tips.
Back in the day, I was forced to put my Dad in assisted living. Don't depend on the official guided tour. Show up at unexpected times and see what the staff is up to when they think no one is looking. Wander around and see if patients are just parked off in hallways somewhere with no one really keeping an eye on them. Invite yourself to lunch or dinner. Is the food edible? Is it hot if it's supposed to be and cold when it should be?
Any outfit that objects to drop in visits may well have something to hide. If possible, strike up conversations with the families who have a loved one residing there. Strike up conversations with the patients who live there. Have valuable belongings ever mysteriously vanished? Does a licensed professional dispense the medications? How difficult is it for a confused patient to wander out the door and be gone for a few hours to a few days?
It is SO hard to find reasonable care. My Dad did in fact wander off from an assisted living facility and vanished for over 24 hours. I was beside myself. He eventually turned up at a local pinball arcade, watching people play the machines. :mad:
After that I moved him to a very nice place that was very difficult to wander away from and was run by an order of Catholic nuns. Even there, someone on the staff stole my Dad's watch.
I am really hoping that I get an especially pernicious form of lung cancer that metastasizes everywhere and kills me in a few months or even weeks. The one upside of smoking.
Lotta great points from Wolf and Sam.
I'll add - Get a few names of patients and talk to their families.
Trust virtually NOTHING from the people who are basically paid to show you how wonderful the place is and all. Many of the liaisons are paid a commission or bonus.
I learned the hard way when selecting an acute care rehabilitation facility, but was very lucky to have the help of some people who had similar experiences to mine.
Maybe the wound needs Hello Kitty Duck Tape?
Wolf, would your friend be able to utilize Home Health services? I know the home situation is rocky, but just want to throw the option out there. I can give you some tips on finding quality agencies in that realm if needed.
Lotta great points from Wolf and Sam.
I'll add - Get a few names of patients and talk to their families.
While this is a good idea, I think with HIPAA requirements and disclosure rules, that you will most likely not be able to get these directly from the home or agency you're looking to do business with. However, word of mouth is a great tool - I'd ask friends and family members if they have any experience with the facilities you're looking into.
Dag
HIPAA covers medical info. Doesn't have anything to do with asking a patient or their visiting family for names or info on the facility. Perhaps I should have been more clear.
Somehow the discharge planner got crazynurse to agree to go to one of the places on my "rancid shithole" list. But apparently they sold her on it because it was a rancid shithole with an on-site dialysis unit.
And let me tell you, it is a rancid shithole.
The first floor is mainly administrative, but the first thing you notice is a strong uriney stench.
And there's carpeting.
One of my ambulance guys told me, "never go to a nursing home that has carpeting."
I do not know why this is true, but it is.
Nobody from her family did a site visit. Her sister saw it for the first time when crazynurse was admitted there ... and is already working to find someplace that isn't that bad. AND she's going to do site visits this time.
Unfortunately most of the not bad places either want better insurance or significant amounts of cash money.
In the meantime, crazynurse is so despondent she's wondering if having had the surgery was worth it, and occasionally talks about just giving up and discontinuing dialysis. Most people last less than a week. I smacked her and told her she's overreacting. She's only been there two days and so far they haven't done anything awful TO her, it's just a genuinely awful place.
They've got patients lined up in geri-chairs in the hallway with several different kinds of movement disorders.
There are some good, efficient staff there, but the ratio of good to lazy-ass is about 1:3.
Tried to get her into the place where my mom was, but they don't take patients with a wound vac.
Oh, and I stood up for my whole visit. She kept telling me to sit down ... I said no, I'm fine ... until finally I told her the truth.
I don't sit on upholstered furniture where there are people with incontinence.
Or scabies.
I particularly don't like scabies.
Jesus....
We're running into a lot of nasties in SEIT this summer. I've been lucky but my coworker was describing staking out a spot on a hardwood floor away from all furniture...
wow - I just read this thread and am feeling kinda sick. Yikes. I've told people this before but this story really brings it home - YOU MUST BE YOUR OWN ADVOCATE (Or, better still, have wolf be your advocate) because the health care system is foooooooked.
Today I will be working on cheering up crazynurse, and as a sneaking side effect, making sure that she eats decently.
I am packing up a picnic lunch that we shall most likely eat in her room, although we may be able to access the cafeteria.
I haven't seen the cafeteria, but I am hoping for those unupholstered hard chairs that I need.
Anyway ...
A little bird told me something.
Doctor GapingMoron from the beginning of the story ...
He just lost his privileges at the hospital.
All of them. Can't operate, can't see patients, can't do ER call, NOTHIN'.
It is unknown whether this is directly or indirectly related to crazynurse's predicament.
But it is strongly suspected.
justice prevails!
bon apetit!
I am afraid of the health care system. Wolf you deserve the title human(e) being
How is crazynurse doing? Is the wound healing?
I haven't managed to be at the nursing home during the right part of a dressing change. When I got there the other night the biofoam was already in place and they were just cutting the hole in the plastic sheeting to attach the suction hose. She has a follow up visit week after next and her sister, who is a registered nurse practitioner (in a field other than psychiatry) is going to be taking a good, long look.
I have been getting calls from crazynurse's family today, all of them ecstatic over doctorgapingmoron's defrocking. Well, not defrocking exactly, that requires intervention by the licensing board, but it is rather like pulling the teeth out of a viper. Just before you cut it's head off.
Mum fought hard to get Grandad into care, and into the right home.
Her friend's father was in the same home until quite recently, and she went to visit it as well as some others.
It isn't perfect - Grandad has a moaner in the room opposite. I don't know what her precise situation is, but she is always in bed when I visit (her door is kept open) and if she is awake she is either moaning, sobbing or occasionally shrieking. Grandad's hearing is really quite poor, so it doesn't bother him. But it's creepy when you're visiting!
He's outside a lot in this glorious weather. There is a lovely terrace, with plenty of shade and he loves it out there, just dozing. It's been a long while since he's been able to go outside because he was so scared of falls in the last two years - he had a really nasty one just putting his rubbish out and Mum had to call an ambulance for him.
When they take him outside he goes in a wheelchair, although inside he is still able to use his walking frame (but must be accompanied). The staff are lovely, and there are enough of them. The food is good - he's eating better than he has in years, but he still sometimes misses his takeaways, or asks Mum to bring him some supper - cheese & crackers and a piece of cake rather than the full meal they serve.
So some places really do get it right.
But again, this is all down to Mum who refused to let him back home when the hospital wanted to discharge him.
Well done for fighting for your friend Wolf.
I would say her daughters need a kick up the arse, but then I know that mother-daughter relationships can be a hell of a lot more complicated from the inside.
Mum asked me to check her emails the other week and I read something that really surprised me, about how we could get on so well sometimes, and I always made her laugh and she had the closest bond with me of all her children - even if I could be a bitch sometimes and make her cry. I was shocked. I thought I was the one who cried in our relationship. I didn't storm out at Christmas and make it a misery all the way through to New Year! So who knows what people feel when they don't communicate well.
Still that, and threads like this, remind me to be kind to her. Human beings are fragile things and don't work forever.
Thanks, Sundae.
The only place that counts as "outdoors" at Horror Hall (uncomfortably close to it's real name) is the entry porch, which is where residents congregate for smoke time. I'm pretty sure I've admitted at least three of them, but I can't remember their names and I ain't asking.
This week I have initiated Operation: Crazynurse.
I emailed an organization we both belong to, of which crazynurse is a founding member.
Folks are jockeying for position on visits, and coordinating what they're taking. One of the paramedics who works in the jurisdiction of Horror Hall is taking her sandwiches tonight, and a firefighter is going with flowers later this week.
I've also arranged (hopefully) for a phone call from someone she hasn't talked to in several years.
Wolf, you are a good egg.
I hope the best for crazy nurse, but knowing you are in her life means she is a step above, no matter what happens.
crazynurse's healing has been proceeding well, amazingly actually, as far as the wound closure is going.
Until ...
She has developed some kind of infection, has swelling and cellulitis in her left leg, and she has gone crazy. Paranoid, raving, trying to escape crazy, but it's delirium (medically based) rather than my kind of crazy.
She's now at the hospital, and I'll be visiting later today to get an eyeball on things.
The crazy could be coming from the infection (not of her primary wound, incidentally), a low PO2 (pulse ox, measure of how much oxygen is actually getting into her blood), or some cardiac arrhythmias (yes, more than one kind) she's got going on.
Right now she's in dialysis, my plan is to head over there sometime later this afternoon.
wow, that's scary, good luck to crazynurse, and goodluck to you wolf.
Nope.
Gram negative bacteria in the blood, not a UTI (first thing you test for in a female nursing home patient, incidentally). Tatadoc says that's usually either bowel or gall bladder ... well, crazynurse had her gall bladder out years ago, so it's not that, which leaves bowel, or something else.
My suspicion is that over at the pitfromhell's dialysis center sterile procedure isn't, and the badbug was introduced directly into her system.
Before leaving last night I had to write a list on her whiteboard:
1. No one is trying to kill you.
2. You are safe.
3. You are not melting.
4. You are at Abington Memorial Hospital.
5. No one is making a movie about you. There are no actors here. Those are real doctors and real nurses. Yes, there is a video camera in the corner of a room. It's to monitor your safety.
6. Everybody you know is okay. You need to focus on getting better.
Her BP crashed last night, and they were having trouble stabilizing it, nearly transferred her to ICU, but they managed her medically okay and she's still on Cardiac telemetry.
I was feverishly (ha ha) texting tatadoc ... she had some concerns stuff was being overlooked and called the surgical resident on call and sent her in to take a look at the things she was suspecting.
leaving shortly to check in on her for today.
Good luck Wolf. Keep us posted.
Today, with a majority of her family in attendance, her BP crashed again.
One second she was talking relatively normally, still bizarre stuff about melting and being inside of a prism (she is having visual hallucinations of rainbows, or maybe is seeing halos of some kind and can't find any other way of describing it), next second she was totally incoherent.
Called the nurse, who called the resident. Foreign resident came in and mumbled something, wandered off.
Happened again worse, with loss of consciousness. Called nurse again.
New shift, new nurse, new attitude ...
"Yeah, I'm done with Frick and Frack. I'm cancelling your CT scan and calling the attending to get you transferred to the ICU."
20 minutes later, she was on the ICU.
Nurse to patient ratio is 1:1, sometimes 1:2.
Telemetry equipment is fancier.
She's still melting.
But they're being more aggressive about treating it.
ICU nurse even straight cathed her, to get urine for a culture. Her kidneys are at the point where she doesn't produce but a dribble of urine, but that dribble apparently looked pretty ucky (which is worse than icky), and it's been sent off for a culture. They are culturing everything on her that doesn't move, and a few things that do. They've even cultured the wound vac from the nursing home in case that was the source of the infection. They're also going to be checking out her fistula (entry ports for her dialysis hookup) and that abdominal CT has been rescheduled for 2230 tonight.
The surgical team keeps coming in to look at her leg wound, which they all agree looks like a nicely healing wound, but they've cultured that too, just in case.
Wow, sounds like they're working it. Good luck wolf.
Oh, and while I was there today, I dropped a little something in the inter-office mail to a guy I know in psychiatry ...
Sounds like they are doing what they can and she is finally in the right place.
Does "a little something" = resume per chance? If so, good luck.
wolf, how much do you charge per hour next time I end up in the hopsital?
yes hopsital. that's what we used to call it. it's more fun
Yes, the little something was a resume, but with a handwritten note to the dude I know rather than a fancy ass cover letter full of additional bullshit. Actually this guy interviewed me about 10 years ago, and really wanted me (as did his daytime compatriot) but they didn't know their boss had already filled the position when they were seeing me.
I type it that way too, monster. And the vehicles that take patients there, they're called ECNALUBMAs.
i do the hospital visiting and advocating for transportation and food. Well, less than that, actually. crazynurse is on disability and she hasn't got any money. But she wants to reimburse me, even when she's sane, because she's a nice person.
You're a nice person too wolf. Don't lose sight of that, don't discount that.
I don't, but it's very nice to be reminded of that every now and again.
Thank you!
*tips cap*
you're welcome.
wolf, how much do you charge per hour next time I end up in the hopsital?
yes hopsital. that's what we used to call it. it's more fun
Yeah, but horsepistol is even funner.
The results are in and the winner is ... Providencia rettgeri
Usually gives travelers diarrhea, but when a systemic infection can cause hypotension.
there's a lot of information about this fairly rare bug online ... including the fact that it is most often a nosocomial infection ... which means it's something that you get from being in a healthcare facility. So ... clean procedure at the nursing home probably isn't.
I'm going to leave soon for today's visit, they're supposed to be moving her off ICU back to cardiac as soon as a bed becomes available there.
Yeah, but horsepistol is even funner.
Wht about HoSpittle?
*giggle*
She's totally out of it now, or nearly. Not quite unconscious, but not conscious, either. She does recognize me, unless she's calling everyone by my first name and saying they're her best friend in the whole world.
And now it may not be P. regetti ... only the first cultures from the ER show it, so it may have been in her, or it may have been artifact or contamination. So they're still looking.
They put in a central line last night ... docs threw me out of the room, probably because they are used to family members freaking out over stuff like that, but oh well. I suspect that they didn't want me to see that the junior resident (he started in July) did the procedure rather than the senior resident that her sister insisted on having do it. But it gives them better IV access and the ability to try meds that might be too much for a regular IV line.
Best wishes for her, poor crazy nurse :(
Grandad always referred to it is as horse-piddle.
Until he was ill enough to have to be in one. Then he too thought it was a film set.
As Classic said, at least they're doing something and at least some of the staff are capable.
And as everyone else says, good luck to her and the best of everything to you for not just caring, but doing something about it too.
Just got a call from crazynurse's daughter.
They put her on a ventilator this morning.
It's not looking good.
I'm going to be leaving shortly to see her.
I'm sorry, wolf. I hope she pulls through this alright.
No matter what happens you've been a wonderful friend. I hope she pulls through as well.
Oh Wolf, you are a really really good friend. I hope for the best for crazynurse, and for you and her family. Hugs.
Wow, Wolf! Sounds like you have done everything possible and then some to help poor crazy nurse. I hope she manages to come out of her continued downward spiral. :(
Just got a call from crazynurse's daughter.
They put her on a ventilator this morning.
It's not looking good.
I'm going to be leaving shortly to see her.
That sucks, Wolf. Good luck to her, and good medicine.
I want to ask "any news?" but that's stupid 'cause I know wolf will tell us when she's able. but I'm hoping crazy nurse is doing OK.
right. no news is approximately equal to "I'm busy." busywolf is more ominous than idlewolf.
crazy nurse is still on the vent. Many of the things they do to manage her blood pressure screws up other body systems. She's loaded with water. They dialized her two days in a row, and have basically used big-ass needles to draw fluid out of her lungs and gut.
She's still intubated, and has a gastric tube. Last night she was opening her eyes, well one eye, anyway, and seemed to recognize that there were people in the room with her.
They are going to continue to lighten the sedation, and are going to try to wean her from the ventilator starting today ... the tubes stay in but they will progressively reduce the amount of reliance she has on the machine. She is already breating at a higher rate than that at which the machine automatically triggers.
Along with the weaning process, they will be lightening the level of sedation,.
And they're sending more cultures of various bodily fluids.
Thanks for the update - sounds like shes headed in the right direction.
Like everyone else has said, crazynurse is lucky to have you for a friend, wolf. I wish her the best, and hope she can pull through this.
Well ... she recognizes me, and found my presence calming.
Darn good thing, too, because she was trying to rip out her vent tube.
Had nearly succeeded before I got there.
And kept trying after my arrival. Even though her hands were in soft restraints, she kept trying to work the tube out of her throat using her tongue and teeth. And she got darn near close, according to the nurse. For a while they put an airway in her mouth to limit her ability to bite down, but then she spit that out too.
Her family are going to get her a whiteboard and some dry erase markers tomorrow.
She kept trying to talk to me, I suck at reading lips ... other than recognizing my name, I think she may have been saying "let me ..." which I assume ends with either "die" or "go," neither of which are an option at the moment. Funny thing about medicine ... as soon as you can express your desires in that regard, you automatically don't get them met.
I spent a couple of hours with her, talking, holding her hand, and reading a couple of chapters from a mystery I wasn't intending to read for a while yet, but when offered a choice between science fiction, an unfortunately bad paranormal romance, and a mystery, she chose mystery. So I'm reading Medicus by Ruth somebody or other ... (Downie) it's set in Ancient Rome, so it's potentially interesting. I'm not liking it better than the Falco mysteries, or the SPQR ones, but we'll see. Perhaps tomorrow she won't remember what I was reading and I can switch it up on her.
I hate those vent tube things. I was on one after a bad car accident, and I panicked over not being allowed to breathe the way I wanted, but had to breathe the way the MACHINE wanted. Hopefully Crazy Nurse will be off the vent soon.
And hopefully, dying will cease to be a possible option in her mind. Best wishes for your friend. Oh, and I bet she'd listen to just about anything you wanted to read her. When I was in the hospital, anything to help take my mind off the discomfort was more than welcome. And that included people reading to me.
Okay ... so a lot of time has passed.
crazynurse is off the vent, she's conscious, alert, talking, and cranky as hell.
She won't eat though. Except peanut butter. Because she says she can't chew meat. She chews fine. Stale bagel is a lot harder to chew than teensy pieces of chicken, which she hides in her cheek and spits out, so I know she can chew fine. And she was chewing ice. So it's not the chewing. Or the swallowing. She won't even consider chicken noodle soup ... and the noodles are so overcooked they're nearly a liquid.
She needs liquid nutrition, or at least mechanical soft food, but for reasons that are unclear, the doctors aren't ordering it.
Physical therapy was supposed to start yesterday, but she was out of the room for dialysis when they showed up, and they didn't come back. She can't lift her leg off the bed at this point, but I'm not sure she could do that before her hospitalization.
I'm pleased that she has improved so much!
This part jumped out at me.
she says she can't chew meat. She chews fine. Stale bagel is a lot harder to chew than teensy pieces of chicken, which she hides in her cheek and spits out, so I know she can chew fine. And she was chewing ice. So it's not the chewing. Or the swallowing.
It sounds a lot like my son. He's 9. He will chew a bite of meat for what seems like a good 5 minutes and still not swallow it because it just doesn't feel like it's ready to be swallowed yet. I wonder if it's some sort of depletion of meat dissolving enzymes in the saliva. He treats meat like chewing gum, the little freak. :)
Thor did that too. Only he'd also keep shovelling more in until there was so much in his mouth there was no way he could swallow......
twit.
Today crazynurse managed some minced chicken salad for lunch, although she did need the crusts cut off her bread (I think that's personal preference rather than difficulty, it's squishy bread), and a pretty decent dinner, based on current standards, cottage cheese, some canned pears, linguini and mashed carrots, and green lime jello. And yes, at one point I did say, "Rainman, come on, eat your green lime jello."
She get some vicarious enjoyment out of what I eat in the hospital cafeteria, which last night was a tasty and varied salad. Tonight, since I can't eat something good for me two days in a row, I had a bacon cheesburger with fries and a chocolate pudding parfait. Hospital chocolate pudding rocks.
I also helped her with some bed exercises (stop that right now) and encouraged her use of the Spirometer. And dimed her out to the respiratory therapist for something naughty she did. According to her sister they are looking to transfer her out to skilled nursing at some point in the near future. I hope that the sister takes better control of the situation this time around.
Punch her. See what happens.
I have the cold from hell and can't go visit until I'm clear of it.
Don't need to add to her infection control nightmare, after all.
I have a runny nose, sore throat, and gooey cough, all of which has responded fairly well to MucinexDM. Love that stuff.
Yesterday was supposed to be crazynurse's day of discharge to skilled nursing (this is the current polite term for "warehouse for old people") for rehab.
Notice the supposed to ...
I got an email from crazynurse's sister ...
Seems that PT came into crazynurse's room. The PT worker had NOT read her chart or ever met crazynurse.
The following conversation is a complete dramitization intended to enhance the absurdity of what happened
"Come on, Mrs. crazynurse, you're going down to PT, you've been there before."
"No, I've been flat on my back in this bed for the last thirty days. I haven't been down to PT at all."
"Sure you have. You just don't remember. You're old and you've been sick, and your memory obviously sucks. Can you tell me who the president is?"
With the assistance of two other idiots, the PT worker hauls crazynurse to her feet (which she can't feel) for the first time in thirty days.
crazynurse already has a REALLY LOW blood pressure.
When you suddenly stand someone up, stuff happens, including something called orthostatic hypotension. You've done this yourself by accident ... you know that headrush you get when you stand up too fast sometimes? That's your blood pressure bottoming out and oxygenated blood isn't making it into your brain.
Well ... when your blood pressure is ALREADY low, guess what happens ...
Crazynurse passed out.
And stopped breathing.
So they called a code.
And intubated her.
And got her up off the floor and back into her bed.
And put her on a vent and transferred her back to the ICU.
So, I get over there, arriving just after her family. Apparently she came to once on the vent. And tried to pull out the tube. So we know she's pretty much herself in there. They restrained her and knocked her out.
What she didn't have was a stroke ... once they knocked her out they scooted her down to CT, and her head didn't show any changes or abnormalities.
She has a lot of gunk in her lungs. Her left lung is completely opaque on the xray, and her right lung is filled up about halfway. So she's not moving air the way she should be.
Nurse comes in, says she's lightening the sedation because the doctors need to talk to her. They deemed her intact enough for informed consent, you see.
They give her a sharpie and a clipboard to write on for her end of the conversation.
First thing she writes? "AM I ALIVE?"
So, cluster of doctors is trying to explain what they want to do (which is to insert a tube directly into her lung to suck the gunk out and improve her breathing).
This is, however, not what the doctor says. I really think that foreign doctors should be required to take a course in communicating effectively in basic English. No alterations are made to the following conversation for dramatic purposes, it's absurd enough all on it's own
doctorgarble says ...
"crazynurse, you have tube in your mouth to breathe, we could put tube through your throat (and points at base of his neck). We want to put tube in chest to pull fluid from lung."
At this point crazynurse starts shaking her head back and forth, and her eyes are wide and scared-looking.
"but crazynurse, you need this"
Further conversation is fruitless.
We were told to be quiet and not interfere.
Yeah, like I'm able to do that.
So I raised my hand and did an "excuse me" cough.
"What we have here is a failure to communicate."
(I love saying that)
"Doctor, you scared the Hell out of her. She thinks you're trying to trach her."
"I didn't say that."
"No, you didn't use that word, but the way you started that's what she thinks you want."
crazynurse started pointing at me and giving a thumbs up ...
"See, that's why she's scared and keeps saying no. Crazynurse, they aren't going to trach you. They just want to shove a chest tube in you to suck out the crap in your lungs. Is that okay?"
Rapid nodding ensues.
"there's your consent."
Another doc comes in, checks her settings, orders a blood test and announces that if the results are good, they'll pull the vent and let her breathe on her own. He shut off the vent, but let it continue to supply oxygen, but only on her demand ... when she actually triggered the breaths herself, it wasn't pushing air into her.
About 45 minutes later, she was extubated.
First thing she says?
"wolf, you saved my life again. How did you know what I was scared about?"
"I could hear you thinking."
And that is why I am not in the mountains with my girlfriends this weekend.
Thank FSM for you, Wolf.
I wonder when hospital staff started thinking about patients as units, as opposed to people? I'm not blaming individuals, just the whole healthcare culture, regardless of who foots the bill.
The care team trying to decide on Grandad's future placed most weight on the opinion of nurses on the ward. Mum of course demanded to be involved and certain things were brought to light. The nurses had no idea Grandad had been delusional (thinking he was on a film set, or that his long dead friend had been to visit, or that he was going to be able to drive home). Because he wasn't screaming and moaning and he said please and thank you.
They also didn't realise he is officially classed as visually impaired, because every time they spoke to him they were already at his bedside and he could work out that what he was seeing was probably a face. They assumed he could see perfectly well.
Thank goodness for people who can intercede, who listen and who realise that things cannot be taken at face value when it comes to health.
And for people like you who care enough to be there.
A Golden Hello Kitty for you wolf, and a standing ovation. way to fucking go. srsly.
...
It is widely acknowledged that you are a gifted storyteller but that's not why even *I* could tell that a tracheotomy was what was being communicated, ffs. Of course, you're an empathetic listener too, but how could anyone miss it, like dr garble??? Anyhow, good job, really. I know what it feels like to be able to "hear her thinking".
My Mom had a stroke in 1997. She's lived in an outstanding assisted living facility since 2001. As a result of her stroke, her mobility is severely restricted, but worse, she has aphasia. Her language center was the center of the bullseye and her speech is limited to one "word": "genna".
This word can be said with lots of inflection, emotion, emphasis. It can be sung or whispered. Her receptive language is pretty impaired too, I've see her answer the question "are you a man?" with a clear affirmative nod. Riiight. I've known men, and Mom, you're no man. She just has a hard time understanding a lot of times. But I've spent a lot of time with her, I have her best interests at heart, and (this is important) she trusts me.
Lots of times I've translated her not-strictly-English expressions into words the doctor/waitress/driver/daughter could understand. Lots. Grateful, relieved nodding follows. Mom's physical disability is a big problem in her day to day life, but she's got a lot of that settled. Her failure to communicate is cruel though. I'm glad you helped your friend, wolf. I hope you know how much that means to her. I do, and I thank you.
You ARE teh awesome, Wolf.
Well played. You should be working in some sort of patient advocacy organization.
she is working in some sort of patient advocacy organization.
what she *should* be doing is collecting a regular paycheck for this work.
Look, wolf. I admire what you are doing for crazynurse, seriously...but is there any possibility of getting her to eat healthier?
The meals you've described that she consumes chills me. She's got to eat better if she's really going to improve. I am sure you already know that. I may be way out of line here, but I am just going to be the one to bring it up.
I can only imagine how hard it would be to convince someone who's been eating crap for so long to switch her eating habits. It was difficult enough to keep my mother on a strict diet while she was recovering from cancer, and she is an organic farmer.
Feel free to let loose on me, I don't mind.
Trust me, I've tried to get her to eat. Good, bad, or indifferent food.
Really the only thing she's getting that's doing her any good are cans of "Nepro," which is a specialty form of Ensure for renal patients.
She nibbled on a bit of pot roast the other night and said she was going to heave.
I think that a lot of this is psychological, but I can't break through it.
And I can't just pick her up a meal from Wendy's which she WOULD eat because of the dietary restrictions.
There has actually been a lot going on over the last week that I didn't get to post about ...
The "Palliative Care Team" got involved with her. There are a lot of vague definitions of that term on the internet. As near as I can figure out, Palliative Care means "we don't think you're going to make it, but we'll keep treating you until we get you and your family comfortable with the idea of hospice."
Crazynurse told them that she "didn't want to live this way," meaning ... just a big lump in a bed, not able to walk or do things for herself. They were on this like sharks on blood in the water.
What crazynurse is is just plain depressed. Her saying that is very akin to a suicidal person assembling means for an overdose. She has a complete tunnel vision regarding her status and ability to recover that is as hard as hell to break through. Her not eating isn't helping her ability to think, either.
Finally, during the official meeting, it seemed to dawn on her what she was being offered, and told them there was no way that she could make a decision about ending her life. So ... they're working on transferring her out to a skilled nursing facility for rehab. The facility under consideration will be very convenient for her sister and mother, and pretty awful for her younger daughter and I, because it's in Cherry Hill, New Jersey.
I do not like New Jersey, and especially do not like driving to it. I may look into NJTransit as an option.
I'll give you a ride. meet you at the Valley Forge Turnpike entrance at 8 am... drop you off around 10:30 or 11pm?
That's sweet. I'll keep that in mind! Thanks.
(assuming that you meant AM, not PM ... unless your plan is to hold me captive in some storage room in the dealership for 14+ hours.)
There were several occasions during the meeting where I want to punch The Death Nurse in the face.
crazynurse's sister was talking about transferring her to a bigger (and presumably better) city hospital. The Death Nurse just started talking about the potential cost of an ambulance transport that insurance wouldn't cover ... "It would be thousands of dollars."
Seriously wanted to punch her.
Besides, an ambulance ride is one of the things I can still get a professional courtesy on.
Another punchable moment was asking for a psych eval by a shrink who just might be able to discern the difference between "appropriately approaching end of life issues" and "major depression." "Why would you want that?" says The Death Nurse. "She already saw a psychiatrist."
"And we haven't been given access to the report or able to talk to that physician."
Actually, she wasn't even really The Death Nurse. She was a pinch hitter. The real Death Nurse had some other meeting.
Damn Wolf ... Seriously, If Jim gets you there I am offering a pick up/ride back.
I NEEEEEED to get outta the house anyway and would love to see you again.
It'd be my pleasure. PM/email/IM me.
I spent two days last week in your county for a class, but not really close to where you are ... at least I don't think I was that close. They cut our lunchbreak down to nothing (20 minutes) to get out of class early, so we didn't get any time out of the classroom (fire department banquet hall with REALLY uncomfortable chairs).
Looks like I won't need to go to Cherry Hill ...
I went to visit crazynurse last Thursday. I hadn't been planning on it, but decided to bop over because her discharge was looming, and I didn't want to miss out on seeing her if she did get whisked away to New Jersey.
So, I show up and she has a glum look on her face.
hmmm.
"An ambulance is coming for me in 15 minutes to take me back to reallycrappynursinghome."
WTF?
The place in Cherry Hill didn't accept her, possibly because her financial POA, her daughter in Saint Louis, either didn't make or return a phone call. Details on that piece are unclear.
So, basically, I'd arrived in the nick of time ... chatted with her a bit, along with my friend tatadoc who was pulling some clinic hours.
And then the EMTs show up with their very fancy litter and whisk her away. They actually showed up within the promised 15 minutes. I'[m not used to that happening. I wasn't planning on accompanying her to the placement ... I had Orienteering class that night.
I didn't follow the ambulance over, but somehow managed to beat them, thanks to directions bitch being set to "shortest time," I guess. I was parked and smoking under the overhang by the time they arrived.
It was a little surreal. The nursing home was having it's Halloween Party. All of the staff, some of the patients, and most of their grandkids were dressed in costumes. The kids were all hyped on sugar, and it was loud and chaotic.
A kitty kat and a vampiress told us what room to go to, which turned out to be next door to her old one.
One thing that was nice ... staff that cared for her while she was there previously kept coming into the room just to say, "Hi."
I stayed long enough to get her settled in, and jetted out of there to get to class, which I made with three minutes to spare.
I visited last night and took her things she's not supposed to eat.
Just when you think that things are going well ...
Much of this happened while I was in New York, so I don't have the full story of what put her into the hospital.
Late Tuesday or early Wednesday crazynurse had difficulty breathing and was delirious (again). She was taken back to the hospital, intubated, and placed on ICU. By the time I was able to see her on Friday, they had declared her stable, lightened her sedation, and she was able to communicate with a letter board. She kept saying she was tired of this and wanted it all to stop.
The physician on her case said that he would not be taking her word for anything until she was off the vent.
She was extubated yesterday. Or rather, as they prepared to do so, they turned their backs on her for just a second and ... she extubated herself. I only know this because her night nurse dimed her out.
(and yes, the balloon was still inflated. nobody is sure how she managed not to really injure herself)
Adrenal insufficiency is the latest medical condition on the table and may be driving an assortment of her problems. They are going to treat for that, the low blood pressure, the depression, the a-fib, and probably three or four things that I forgot.
So, now that she's talking, everybody had a really long and detailed conversation about end-of-life issues ... and she has decided to remain a full code, and is no longer wanting to talk to the death nurse.
Jeeez. This has been quite a run.
It's been a bad couple of days.
After being off the vent for three days, last night crazynurse went into respiratory distress, and was put back on the ventilator. She is only under light sedation, and when awake, she is aware of who we are and able to comprehend what's going on.
Her family and I are meeting with the hospice team tomorrow.
If there may be poetry in death, she would hang on until November 23rd. That way only one day will have to suck for the family. You see, 20 years ago on that date, her husband passed away.
She would like to die at home, in much the way her husband did, surrounded by friends and family, however, at this point, she may not survive the transport.
So sorry to read this Wolf.
Damn, for a while there she seemed to be getting better.
Wolf, sorry to read this. I wish you and Crazy Nurse's family peace and tranquillity on the road ahead. You're such a good friend to have - bug hugs to you for being there when your friend needs you.
At least she's had you through all this wolf. You've made things better for her.
Sorry to hear this, wolf. You are a good friend.
At least she's had you through all this wolf. You've made things better for her.
^whs
Mum thought Grandad was holding on until the 30th, the anniversary of Nanny's death.
Personally I think he was simply an East End boy used to stubbornly holding on to what was his, and his strength gave out.
Wolf you have made a big difference in the lives of her and her family.
And all the kind things other posters have said.
Sorry it's turned out this way.
So sorry, wolf. I hope crazynurse is able to make it home...
Today we are meeting again with the hospice team, and should find out whether they have deemed crazynurse stable enough for transport home. They are doing one more dialysis this morning, so that she'll (hopefully) be clear enough when her granddaughters get her to have some good time with them. That was a cluster to begin with ... before crazynurse got really sick, her daughter moved to Saint Louis. When crazynurse's sister called her Wednesday night to say, this is it ... she's going on hospice, the daughter says ... well, I can't take the kids out of school early, and I'll leave (driving) on Saturday ...
Yeah. We don't expect her to make it that long, dumbass. Get your ass on a plane.
After a number of really angry phone calls and emails, the daughter has agreed to fly, and will be here this afternoon with the grandkids.
It's so sad. :(
I'm really sorry wolf, and ditto what the others have said about having you as a friend.
[/Off topic]
My mother-in-law went through something a bit like that.
My wife made drove from PDX to Montana with each crisis.
We finally got the "This time it's it" call, and she made the trip again.
When she got there, the hospital room was filled with family.
As Edy opened the door, her Mom woke up, looked around, and said:
"I'm so glad you could all come to visit me"
MIL lasted for several more weeks.
[/Back to OP]
Sorry to hear all this, Wolf.
We brought crazynurse home last night.
But we didn't have time to warn the neighborhood.
You see, in emergency services, there are ways to welcome people home.
IMAG0131 by
Storm Hawk Rising, on Flickr
The family knew this was going on.
The neighbors didn't. And crazynurse didn't.
Oh, and neither did the guys driving crazynurse's ambulance. As they come around the corner, all they see is flashing lights.
"Something's going on. I don't think that's your house ... Oh, it's your house ..."
IMAG0136 by
Storm Hawk Rising, on Flickr
IMAG0137 by
Storm Hawk Rising, on Flickr
This is how we do it.
IMAG0139 by
Storm Hawk Rising, on Flickr
Special Thanks to Towamencin Fire Company and Lansdale Volunteer Medical Service Corps. When they left, they hit the sirens.
crazynurse was either a founding member of Lansdale VMSC or darn close to it. And definitely is a founding member of the Montgomery County Critical Incident Stress Management Team.
And an EMT and paramedic instructor. She has had shiny new EMTs come up to her and tell her that she taught their parents or grandparents.
Just wow.
That's a homecoming.
Are you in the pic, Wolf?
I don't think I've ever seen you before.
That was really nice of them. Most tributes are posthumous, she was able to enjoy her's. I think it may get the neighbors involved in the time she has left, too.
I am not in that photo, I'm taking it.
One of my friends took a picture of crazynurse and I in the hospital, I'll see if I can get it from him.
Wow! That's awesome.
Was she alert enough to appreciate what was going on?
That is touching, amazing. It hits me right in the heart.
Warm thoughts to all of you...just wow!
Crazynurse was alert and aware during her homecoming, as well as throughout today, much of which was spent holding court for a number of visitors, Including several folks from the nuthouse I havent seen since that fateful day in April. Not sure how many "good" days we have left. Tonight we watched Dances with Wolves, which is one of her favorites.
I also spent time entertaining her seven year old granddaughter. We made a yarn doll, a God's Eye, and did some finger-knitting.
I have to get some sleep, its my turn to cook tomorrow .... Beast Stew and Drunken Dragon Dogs.
Wolf, I know we keep saying it, but you are a true friend. Blessings on you!
I too am impressed by "wolf", and have enjoyed all of her postings.
The world needs many more wolves because we are all likely to become Crazynurses.
I am so sorry to hear this wolf. I was hoping that she had turned the corner on the way to recovery. She is lucky to have had a friend like you by her side this whole time
its my turn to cook tomorrow .... Beast Stew and Drunken Dragon Dogs.
I remember the Drunken Dragon Hot Dogs. They sound a bit salty for my palate, but I could tinker and use real toms rather than tom sauce.
I reckon some pineapple would go well too...
:) You're a good friend, wolf.
I remember the Drunken Dragon Dogs, too.
:)
Crazynurse passed tonight at around 12:12 pm on 11-21-11. There is more to say, but I can't do it right now.
Thank you all for your kindness.
Sorry to hear wolf. That homecoming was great to see, gotta love how health care folks look out for each other even with the little stuff.
Wolf I am so sorry to hear this. Know that you did everything possible to help your friend. My thoughts are with you.
Sending hugs to Wolf.
I'm sure you made things better.
Hugs from here as well. You did everything and more than a friend could. I'm sorry for your loss.
I'm sorry too wolf. *hugs*
I'm sorry wolf. Thinking of you.
wolf, maybe in the near future you'll find some comfort in this:
I was so impressed with crazynurse's homecoming. I was telling my mom about it. She worked at the hospital for years (in registration) and has the utmost respect and admiration for people in the medical field, having seen every day what they do for people.
She exclaimed "Well isn't that wonderful?" and we both got a little teary at the idea.
Your friend touched the lives of people she's never even met. That's pretty amazing.
Sorry, wolf.
I've been thinking about that homecoming over the last couple of days. It was really beautiful. You are a most excellent friend.
Well, shit wolf. I'm so sorry. I don't know how (but you do) please take care of yourself *TOO*. I know, we all know you take care of others. Give yourself some of that love too, for us if you must.
((((((wolf))))))
sorry to hear this Wolf ,
glad she had a friend like you to help her thru this
Your friend touched the lives of people she's never even met. That's pretty amazing.
As do you, Wolf. You are a deeply compassionate person.
So sorry you lost a friend.
Thank you for sharing her story with us.
I am so sorry to hear of her passing. You absolutely inspired me with all that you did for her. I can't imagine how difficult, frustrating... it all must have been for you.
I think ANYONE would be truly blessed to have a friend care for them as you have.
Again, I'm so sorry for her and her family. My condolences to all.
Hugs to you.
Sorry for your loss, Wolf.
I'm sorry about your friend's passing. At least she was home where she wanted.
I am at home. Yesterday was spent making the arrangements with the funeral director, which is another entire story to tell.
Crazynurse's homecoming was followed by a weekend of joy, love, and laughter. Visitors came to share memories, and occasionally tell a bad joke.
Each night crazynurse chose a movie to watch. Saturday was Dances with Wolves, and Sunday was Spaceballs. We were going to work our way through some other Mel Brooks movies next.
While we were watching the movie, crazynurse's 15 month old grandson was playing alone in the kitchen. He was running around and giggling, showing one of his first birthday cards to someone, and running around like he was being chased, and holding his arms up the way he does when he wants to be picked up by someone. The older daughter and I were watching him, looked at each other and wondered if he were playing with Pop-Pop Bob, who had promised to come for crazynurse when it was time.
As her daughter and I were settling her in for the night on Sunday, crazynurse asked me if I were staying. I had prepared to do so, and had a bag at the house already. I told my intention for that night was to go home, but that if she wanted me to stay, I would stay. She asked me to stay, and so I grabbed my bag, brushed my teeth, pulled off my sweatshirt, kicked off my sneakers and laid down on the couch.
Notice, please, that I didn't say that I got my adorably cute jammies out of my bag, put them on, and laid down. I was fully dressed.
We were all exhausted. I was asleep within a couple of minutes.
I had a very vivid dream about going to talk to crazynurse's spirit guide, and to offer her food for the journey. Her daughters both told me (the one in the room next to her, as well as the one with the baby monitor, that they heard crazynurse and I talking to each other … but “not in English, in some other language I never heard.”)
I woke up suddenly after that, I think in response to a change in crazynurse's breathing. I woke up her daughter who got the younger daughter downstairs.
Within a few minutes of that, with all of us there talking to her, holding her hand, crazynurse passed, at 12:12 am on Monday, November 21, 2011 … not the exact 20th anniversary of her husband's death, but, like him, three days before Thanksgiving.
Mary Jane (Hoffman) Smith
Born:*July 04, 1946
Died:*November 21, 2011
Services: *Relatives and friends are invited to attend her Funeral Mass at 10AM on Friday, November 25, at Corpus Christi Catholic Church, 900 Sumneytown Pike, Lansdale, with burial following at George Washington Memorial Park.
Visitation: *Family will receive friends on Wednesday from 6-8PM at R. L. Williams, Jr. Funeral Home, Inc., 3440 Skippack Pike @ Cedars Rd., Skippack.
Mary Jane (Hoffman) Smith, 65, passed away at her Towamencin Twp home on November 21, 2011. She was preceded in death by her husband, Robert G. Smith, in 1991.
Born July 4, 1946 in Philadelphia, she was a daughter of Mary Jane (Clary) Hoffman of Southampton, NJ, and the late Roy Hoffman. She was a 1964 graduate of Academy of Notre Dame in Philadelphia, and a 1967 graduate of St. Joseph Hospital School of Nursing in Philadelphia.*
Mrs. Smith was a registered nurse. She worked at the former Philadelphia General Hospital and then Montgomery County Emergency Service of Norristown. She was a founding member of the Montgomery County Critical Incident Stress Management (CISM) team and served as the clinical coordinator, was a paramedic and E.M.T. volunteer at Volunteer Medical Service Corps of Lansdale, and a Montgomery County E.M.S. and E.M.T. instructor.
In addition to her mother, she is survived by two daughters, Barbara Jane Fallon and her husband Matthew of O’Fallon, MO, and Mary Elizabeth Harris and her husband Dennis J. of Lansdale; a sister, Catherine M. Cheeseman of Sicklerville, NJ; and three grandchildren, Bailey Renee Smith, Shaela Robin Fallon, and Draven Robert-Jeffrey Harris.*
In addition to her husband and father, she was preceded in death by a brother, Roy A. Hoffman.
Relatives and friends are invited to attend her Funeral Mass at 10AM on Friday, November 25, at Corpus Christi Catholic Church, 900 Sumneytown Pike, Lansdale, with burial following at George Washington Memorial Park. Family will receive friends on Wednesday from 6-8PM at R. L. Williams, Jr. Funeral Home, Inc., 3440 Skippack Pike @ Cedars Rd., Skippack. In lieu of flowers, contributions may be made in her memory to CISM, EOC c/o EMS, 50 Eagleville Rd., Eagleville, PA 19403. Online condolences may be made to the family at www.RLWilliamsFuneralHome.com.*
Memorials:*In lieu of flowers, contributions may be made in her memory to CISM, EOC c/o EMS, 50 Eagleville Rd., Eagleville, PA 19403.
We'll all miss you Janie.
Wow, that dream and speaking in tongues thing is spooky.
When I go, I want it to be like that. Seriously, I can't think of a better way. Surrounded by loved ones in my own house. You did good, wolf.
Oh Wolf, how moving! How marvellous that you helped her to be at home, surrounded by love an laughter (and bad jokes) in her last few days. That really does sound like it couldn't have been any better. Well done, for all you did!
There was at least one narrowly averted disaster involving a visit. There was a group of (mostly) nurses that worked at the nuthouse who came to see crazynurse. These ladies called themselves "The Sisterhood" and had a lot of good and crazy and supportive times with each other. All of them had arrived at one time and were having a joint visit.
I was busy in the kitchen doing some cooking, and letting them have their time. One of them came up to me with a smudge stick and a candle and asked me if I had any matches.
"Not for you!" I said.
She was quite taken aback, thinking I was being insulting toward her and their wanting to do a ceremony to ease crazynurse's transition ... before she could blast me (I saw it building up), I said one word that changed everything. "Oxygen."
They're nurses, but they're psych nurses, you see.
So, they thanked me for preventing them from blowing up themselves, crazynurse, and the house. I taught them how to do a dry smudging, and they proceeded.
At one point they asked me into their Circle, because crazynurse was again thanking me for all the help and support I had given. One of the nursesisters made mention of the empty place in their circle, and how they would honor her. Then crazynurse did it. She suggested that I should be brought into their circle to hold that space.
So, I've been inducted.
As they went around the Circle, saying their last goodbyes, I started some chants for them ... The Peace Chant (an intertribal), and then Atabey (Earth Mother's) Change Chant (a Taino/Central American chant).
Crazynurse sure liked it. So did they.
And now I'm invited to a Christmas Dinner, at which there will be an empty chair with a Strawberry Daquiri at it ... and a glass of water, which crazynurse said she'd make move to show that she was there with them.
cheers to you, cheers to crazynurse.
Oh, wolf. How touching!
How beautiful that you were there with her!!
It sounds like a really good passing.
peace, my friend.
crazynurse's funeral was today.
It turns out that I remember a lot of the Catholic Mass. That thing, where they say give me your children to me until they are twelve, and they will be mine forever? It's kind of true.
It was a lovely service. The priest's homily was very good, and hit on a lot of significant points of crazynurse's life and work, rather than being a cookie-cutter "she was a good wife and mother" sort of thing.
After the communion, I was invited to the altar for my eulogy. One of my friends said that as I finished, the sun came through the stained glass windows, and lit first me, and then the whole altar.
I didn't notice. I was busy trying not to lose my place. Or stutter. Or fall down the altar steps when I finished.
I made her mother and daughters cry, and a lot of people laugh. I gave the printed copy to her mom. Everybody seemed to like it.
The last four months have been a trial, both for Janie and for everyone who loves and cares for her.
Which, if my math is right, leaves 780 months of pretty good time, so the last four months comes out to half of a percent. Let's remember best the other 99½ percent of Janie's life.
I met Janie not quite 30 years ago. I was her husband Bob's friend. He brought me home one night and the family decided to keep me.
Some of you have known her longer than that, some less, but we all share something other than just knowing Janie.
In some way or another she has touched every single person in this room.
She may have been the paramedic who came to care for you.
She may have been the psychiatric nurse who helped you find hope in your darkest hour.
She may have been the friend who listened without judgment, or with it, if that's what you really needed.
She may have been the critical incident stress management peer who guided you through the shock and fear of a bad call.
She may have been the instructor who didn't just teach you, but got you excited about learning.
She may have been the wife you loved deeply and dearly.
She may have been the mom who dried your tears.
She may have been the daughter who always knew her own mind.
She may have been the foster mother who let you know that you were a real part of the family.
She may have been the sister who took the blame for something you did.
She may have been the Mom-Mom who spoiled you rotten.
She may have been the aunt or cousin that brightened every family celebration.
She may have been the person who was always there with an open heart, ready to help at a moment's notice. Well, if you didn't mind that that moment might be at least a half-hour later than you expected it to be.
She may have been the best friend who frustrated you because she never listened.
From the 4th of July, 1946 to the 21st of November, 2011 Janie became a part of a lot of people's lives, and now, through each of our lives and actions, she will continue to change lives.
What she has done does not end here, it begins as we continue where she left off.
She is at peace, and let us all find peace and hope in carrying on for her.
As we drove to the cemetery, I was listening to a CD in the car. It was a "mix" CD I had burned nine or ten years ago. It's labelled "atomic." It has every song I could find about the Atomic Bomb ... Hiroshima by Utopia, Enola Gay by Orchestral Maneuvers in the Dark, Manhattan Project by Rush, the classical piece Threnody for the Children of Hiroshima, and so on. Well ... there aren't 80 minutes of songs about the bomb, so I filled the rest of the CD with other stuff, including the original and the 1995 remix of Paul Hardcastle's 19, and, a song I do not remember being part of the CD ... It's Raining Men.
Crazynurse LOVED that song. At every nuthouse party, the song would be played, crazynurse would go to the middle of the dance floor, and every single man at the party, employee or not, was told by their wives and girlfriends to go dirty dance with crazynurse.
So, after I got over the shock of discovering this on my CD, what did I do?
I played it all the way to the cemetery. LOUD. With the windows and sunroof open.
Oh, and another funny thing. The cortege was lead by the hearse, followed immediately by an ambulance. There were a couple people scratching their heads over that one ... Nice little bonus ... the ambulance has that thing that turns traffic lights green ... so even though it's common for a funeral procession not to stop, we actually didn't have to for the entire ride.
love the eulogy, still so sorry you lost your friend.
Wolf your eulogy has me in tears.
I didn't know her except through you, but I'm crying for her anyway.
Thank you.
What a fantastic eulogy, for someone who was clearly a fantastic friend! You are so right when you say that we can continue what the friend or relative we have lost gave us even when they are gone.
Anyone can do the right thing once, or every now and then.
It's much harder to do the right thing day after day - to keep giving even when you're tired.
Well done, Wolf.
Keep an eye on that water glass. You never know.
Wolf, I expect you to be employed very soon. You have done so much above and beyond the call of duty in the name of friendship and love, but in a professional and caring manner, it's impossible that someone who needs a person with your qualities hasn't noticed
..and I don't just mean what you did for crazynurse, which obviously wasn't duty...
wolf, your eulogy made me cry too. thanks for that, kinda.
you're a good person, a good friend.
So, I spent most of yesterday humping stuff from one place to another, in this case crazynurse's house to a storage facility.
Well, there was this one little side-trip.
There was some extra furniture that crazynurse's daughter gave to me.
Nice furniture.
Well, better than furniture, really.
Only thing is, it was kind of disturbing this morning when it woke me up for the physical jerks, but after BB's speech, I feel much better, happier and content.
Only thing is, it was kind of disturbing this morning when it woke me up for the physical jerks, but after BB's speech, I feel much better, happier and content.
I don't understand this at all, but are you saying she gave you the TV? Holy cow!
I don't understand this at all, but are you saying she gave you the TV? Holy cow!
Do the words "Room 101" mean anything to you?
(I'm not trying to sound as snarky as that does when I read it after initially posting it. I thought the book was required reading in most high school lit classes.)
Yes, crazynurse's daughter and son-in-law gave it to me. gothychick and I moved it into my apt yesterday. I can't wall mount it, so they gave me the stand too.
you fell a sleep with the TV on ??
OK I'm totaly familiar with that book, wolf, but I didn't get the reference either. I assumed crazy nurse had some sort of exercise channel programmed as an alarm, and I couldn't work out what the hell Buster had to do with it, just wondered if I'd missed a blossoming cellar relationship.....
Yes, crazynurse's daughter and son-in-law gave it to me. gothychick and I moved it into my apt yesterday. I can't wall mount it, so they gave me the stand too.
Cool !
Ha, no, 1984 as required reading became cliche, no one I know (that's my same age) was required to read it. I did have to read Lord of the Flies, The Scarlet Letter, Catcher in the Rye, and Grapes of Wrath though, so there was still plenty of cliche to go around.
I believe the reason that 1984 was dropped from the curriculum is that it now counts as current events.
Ba-dum-dum TISH!