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.

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.

Wht about HoSpittle?

When was she in RI? (Providence)

*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. :(

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.

Best hopes for her.

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. 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.

You go, 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.

Wow. speechless.

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.

Sorry, wolf :(

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.

^whs