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....

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 ...

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.

I don't know why, they're basically just sterile audio foam... oh wait, audio foam is hella expensive too.

The Adventure Continues ...
 

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.

: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.

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.

http://www.medicare.gov/NHCompare/st...ub&PubID=02174

a pdf from here:

http://www.medicare.gov/nhcompare/in...rch.asp?bhcp=1

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.

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.

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.

UTI?

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.