Monday, February 23, 2009

Where Otis moves to step-down and eventually to OR.

Okay, O - as we now know he is called, is out of our unit. He is in step-down, and as of this AM, should have been in OR getting a valve. Whatever happened to get him from waiting to die to this, I don't care. The man is getting better, in spite of the dire predictions. So, he is a happy one.

I have enjoyed thinking about him and hoping for him and praying for him. I did make him the center of thoughts- and if that was anything that helped, then good for him.  I am glad he is getting out. I do think that he will be changed for the better when he leaves- he is talking, and more outgoing. I am glad. I hope I get to see him again.

Mrs. Reader did indeed die on Monday. I hope her passing was okay. Mr. W died this morning- I was with his wife as she said goodbye. She wanted to be alone when he passed, and she held his face, kissing him as he took his last labored breath. It was very peaceful- his pressure just kept dropping, and then asystole ... nothing dramatic, thank God, just quiet. She will be okay. And, she will see him soon.  

It's so very strange that we have so many patients on comfort care right now. I am not sure where this is coming from- but odd, and very atypical for us. We have two still there that are heading towards comfort care. I am not sure why we are keeping them- well actually, their 02 requirements are too high for hospice. So, we get them. It's okay, but I worry that we may miss a point where a patient that needs a bed does not get a bed.

Mr W continued to run into V-tach- I guess they had the same issue all weekend, too. I took a picture of him for his family and sent it to them- he looked great; this was before his horrific run of tach-flutter (!) and his at least 6 shocks- just last night. Talk about PTSS....  He was so grateful for that to occur- seems as if we should make computers available for patients in the hospital so they can stay in contact. His wife was just out of hip-replacement surgery and can not visit him. He heads to OR for LVD on Wed- I hope he makes it there. He is also on the list.  So praying for him, too.

So, here is the quote for the weekend. From Nikolas-  "Do not trust anyone who is wearing a bow tie in a code. Just don't".  Point taken. Patient did not even make it to us.... He was a bit pissed.... 

Break is here!

I am sure it will be over before I know it, and certainly have plans to do nothing. Is that possible??

Inertia is an impressive force. Its one that apparently  I generate. Because when I am at work, NOTHING happens. Nothing. A huge big fat ZERO.  When I got home this am, Art was still sitting at the table, just waiting for me to make coffee (not going to happen) and make some sort of breakfast. After all, I was coming home right? Not going to school? So, I can do the horses, right? I mean, I have only worked all night, and since I am there- why not?

I can think of more then a couple, actually.  So, my dad's plan might have to coming to effect. I might just have to stop doing. That is not something that comes naturally. Not at all. But overall, maybe I can start in that direction. If not, I am going to get pissed (which is easy after no sleep, so try and keep that thought, missy, and remember it so you don't get all hot and bothered. Count to Ten- or 100, if that works better...)

So I have mountains of laundry, and still am looking at all the shit that needs to get done around the house. Watch Art sleep (HOW can he sleep with me during the day and also sleep at night??? How can that be?????) and still stare at me when dinner time approaches? 

It's hitting critical mass. There is one thing for sure. You do not see fit, thin men in our unit. You see men that are not fit and overweight and have just overlooked the fact that they need to take care of their bodies. No matter, I can say it again and again, try all my ideas, and nothing comes to fruition. Kind of irritating.  Okay, new post, no vent, all done. :-)

Wednesday, February 18, 2009

There is something different about  Teresa Chambors, 29. Brown eyes behind glasses, blond hair and a mid-length pink dress and bright red shoes, it’s hard to pinpoint exactly what it is about the Eastern Michigan University student.

She moves a bit slower than other students. She opts to take the elevator whenever possible. Her hands often shake as she attempts to write. But Chamber still manages to hold onto her 3.7 GPA.

It's what you can't see that makes Chambors different.

 Chambors has someone else's heart beating in her chest. 

At the age of 12, Chambors entered a maze of doctors, EKG's, cardiac echos and heart catherizations. Dr. McDonald Dick, head of Pediatric Cardiology at the University of MIchigan Hospital delivered the devastating news.

Chambors had Polymorphic Ventricular Tachycardia. Her heart would begin to  beat too quickly, often as a result of anxiety. Unlike others hearts, hers could not stop its frantic pace- in many cases, it can lead to sudden cardiac death. 

Chambors also had developed Idiopathic Cardiomyopathy, a condition where the heart has sustained irreparable damage. Because hers had been working overtime, the damage was done and was permanent. 

Chambors said she spent the next 10 years taking drugs to help her ailing heart function.  The condition ruled her life with numerous hospitizations, doctors visit and tests to monitor her health.  Often only able to stay away for five or six hours a day, Chambors said her social life, the pinnacle of most high schoolers' experience, was non-existent.

"High School was hell," says Chambors. 

Eventually the drugs stopped working and Chambors said her heart was getting weaker. She developed blood clots that traveled to her kidneys,  destroying 35 percent of their function- a condition she still has today. Chambors said she was hardly able to get up four stairs without stopping to catch her breath. It was clear, she needed a new heart. 

In July  2001, Chambors was placed on the "list". She joined the other 2000 plus people waiting for hearts in the USA. Many die waiting for their chance at a new life.

On January 26,  2002, Chambors said she got the call from the University of Michigan- a heart that matched had just become available. After seven months and two days waiting, her tiring heart was removed and another placed in her chest.

Chambors was the 498th heart transplant done at the U-M. 

Much later, Chambors said she was told her heart would have probably only lasted another two weeks. 

Chambors would love to meet her donor family. She has sent several letters, thanking them for their gift of life; thus far, she has not heard from the family. 

Chambors says she  considers such people like Dr. David Dyke and the other doctors and nurses on the heart transplant team her friends. She spent more time in the hospital then she did at school for those 10 years and said she forged stronger bonds with them then fellow students.

Mark Brown, a nurse in the new Cardiovascular Center at the U- M remembers Chambors pre- transplant. 

“You get to know them if they are frequent flyers,” says Brown. 

Chambors certainly qualified for that status- unable to actually account for all her days hospitalized, Chambors recalls several stints longer then a month. 

"The worse experience of my life was being on a vent." says Chambors. "It's like feeling you can't breath and you have to suck air through a straw." 

Chambors was on a ventilator two times, eventually getting a tracheostomy.

Chambors considers herself lucky. She says her transplant was considered one of the top 10 matches ever done at the U-M. Her chance of rejection, always a concern, is low. According to Chambors, this also means she has to take less medications daily then if the match was not as good.

As it is, Chambors says her meds still run a staggering $400-$500 a month- with insurance. Without drug coverage, she estimates her costs would quadruple.

Chambors still lives with her parents in Canton, and her "very important dogs."  She loves to talk about her pets, her beading and her card making instead of talking about her health. 

But, there are things that remind her. The medications make her tired. She must get eight to nine hours of sleep a day to keep up her energy. She takes the elevator and walks slowly to conserve her strength. Chambors carries a water bottle all the time as she says she is always thirsty, another side effect of the medications she must take daily for the rest of her life.

Chambers qualifies for federal disability. But she chooses to go to school, which disqualifies her for assistance. That's just fine with her. She says she just wants to blend in with other students and experience college with as much normalcy as possible-something she missed earlier in life.

Chambors was hospitalized last month, missing two weeks of classes which put a damper on her winter semester.  She said she is grateful to her professors for working with her and assigning work over the internet.

Dr. Lisa Bank, her ecology professor at EMU says she is keeping up- better than some of the other students who don’t have the excuse of illness. 

“They (professors) were great- I had my laptop at the hospital and was able to keep up on assignments and emails,” says Chambors. " I think I might keep my A average.”

Contacts :  Teresa Chambors- Phone 330-232-2828

Monday, February 16, 2009

wow- just wow

That says it all!

Think of a moral dilemma you might face at your place of employment. Choose one theory of action morality and use it to determine the morally correct

Think of a moral dilemma you might face at your place of employment. Choose one theory of action morality and use it to determine the morally correct course of action. Discuss the dilemma and the applicaiton of the moral theory.

journal question #1- medical ethics

I admit this question stymied me- I am not sure about what action morality is, honestly.  

I work in a place where there are a lot of decisions made for patients who cannot speak for themselves.  I would say that each shift I work, there is always some question that floats around the unit- "Are we doing the right thing for this patient?" I never hear "Are we doing the right thing for the hospital" or "the bottom line" but since I am in a caring situation, those things will not confront us when we are at work- our goal is to save the patient. At times, this is against all odds, and one does wonder, is it against what the patient herself would want?

Quick one sentence situations- A very intelligent MD, at the end of his life, wanting to prolong it even though this involved shocking him numerous times- his wish was to shock. A 96 yo woman who keeps saying "I want to go home" and her kids don't/won't listen.  A non-compliant patient, although one that was learning how to take care of himself, getting left off the txp list in what can only be described as a personality conflict.  A man who was not quite homeless, but had defiantly taken a turn towards that, who had no family, but health insurance being kept alive because no one had the legal right to say let him go. 

So, I will take the last situation. It's interesting, as this patient was thought to have no health care when he came in. He was driving with a friend, and was able to get to his destination, and when his friend got out of the car, he was found slumped over the steering wheel, unresponsive. It took a fair amount of time for the EMTs to get there, and when they did, he had no rhythm . He was shocked and brought back into a sinus rhythm.  Estimated time down was 10-20 min, but since there was not a good person reporting, it was hard to know. 

He was brought to the U, placed in intercool, a balloon pump, and a vent. He had a swan placed, a picc and an a-line, in addition to peripheral lines. Upon admission, he was missing toes, and his feet were in a horrid state- indicating that his diabetes was out of control. Indeed, his first BGL was almost 800. 

He had no next of kin, we could not find him in our system as having health care, and his friend reported that he had not seen a Dr. in over 40 years.  We eventually found out that he had already paid for his cremation,  and while not having an advanced direction, seemed to accept that when his time to go was time- well, it was time to go. It was also discovered that he had good medical insurance, through Ford. 

Since he had been with us, he had shown no signs of meaningful life. He was heavily sedated to be sure, but even when he was not, there may have been indication he was sensitive to changes in light, but his pupils were fixed and dilated. 

One of the RN's reported that his care was upwards of 150k a day for the first few days. With the vent, and the balloon pump and intercool, those machines in themselves run about 15-20k a day. He was on at least 10 different drugs and subjected to many tests each day, including lab tests every hour to manage the insulin levels. It was mandatory that we continue treatment. 

So, the question is this: This man did not have family, he did not have the wherewithal to take care of his own needs; He had one tooth, no dentures, and uncontrolled diabetes. Since he had health insurance and could afford care, he choose to not take care of himself. He must have been in a fair amount of pain given the state of his feet. 

So, given this silique, one would suppose that Kant would support the decision of the hospital. This is in direct opposition to utilitarianism-where the support of well-being and to alleviate suffering seems to be in diametric view to Kant and in this case, moving to palliative care would have been the correct thing to do.

  Where I get confused is the issue of happiness...or supporting autonomy. It seem that Kant also supports the dignity of the person. This seems to be clearer to me- the gentleman here did not seem to be the type of person that would support this continued support. But we have no way to know.  But if we were to assume, Kant would also support not continuing "extreme measures" in this case, and this man was unwilling to take even the smallest measures he controlled himself to ensure his health. 

We'll never know in this case- this gentleman suffered extensive system breakdown after 2 weeks on our unit. In the end, there was no saving him. We knew this from the moment we got him on the floor, but nothing could be done.  

In this case, using utilitarianism (Mill) and Kantism seem to lead to the same path. I guess that's what made it all the more frustrating for us as health care people.

Friday the 13th was just that. had a lot of things happen that added up to making it a rough day. I admit, it was not rough for me as much as for others. I just carried it a bit too far! :)

So it appears that I might be back to looking at schools out of state. I am not 100% sure, but if things close down here, there is no reason to stay in MI. Tryon would be great, but no PA school close to there. If the farm sells, then I have the freedom to go where ever I want. This is nice to think about- yet also exhausting. Not sure what would happen with Nick- that remains an issue for me. GH is great for him, and would like for him to stay there, but also know that his dad is NOT the best influence on or for him. In addition, I am not at all ready to let him fly on his own at all. Nor is he ready to not have me breathing down his neck...I am sure that is how he sees it!

Off to Gaslab!

Friday, February 13, 2009

Just got a call...

...which was nice for the day from the husband of a patient that I had a few months ago. I gave them my phone number just in case they needed something. He called just to say that he had been carrying my number, and they were so glad that I had come into their lives- and just...such a nice thing to get.

This has been a really difficult day. Just tough. I am not sure what I can do about it- the issues are so varied. At times, it would be so much easier to just say- Okay, I am doing this alone- I cannot carry you and me and everything else. 

yet, I understand how it is. I really really am understanding now- 

I don't understand the whys- but, I am beginning to see that the importance of love is deeper then just the surface and that perhaps I need to take note. I have a connection that is so much deeper then anything that I could have ever thought possible.  I am very very much in love.  I am in love with a spirit, with a soul, with an etherial being- but a physical one, too- even though I  don't know that physical being. It is the type of love I feel for my children- inexplicable but very valid. It does cause a physical pain- which is so strange, as I can also say I have never been as happy as I am, too. What a coin....

What is your reaction to our discussions of assisted reproduction?

Timely, I think! :)  

I don't have an inherent negative  reaction to the idea of a surrogate being used in the case of many that we spoke of. I do, however, have an issue with people hiring someone to carry their baby because it's just too hard, or their job is too pressing. For those that consider pregnancy a burden, I have news for you. Parenthood takes a lot more out of you.

 I must add here that being a parent has been great for me. I love my kids, and am so proud of what and who they have become and are becoming. I did not have the parents that make me the ideal mom- indeed, I had my daughter when I was 20 and single- hardly ideal. But in our case, things went really well, she is a lovely 26 year old woman, and I am very proud of her. I took care of her needs myself, and we did a great job together. To this day, we are still very good friends- and yet, when she needs, I can still be her mom. 

So, I do differ from a few- Motherhood was important to me- perhaps not in the way that conjures up the biological clock- who has a biological clock at 19?? But for me, I think it was a way to right a wrong. I remember saying to myself at 10 that I would not do my parents had done.  And it meant a lot to me to create the magic and joy that I have always felt childhood could be. It's not always that, needless to say, but for the most part, my memories of these times with the kids when they were young are full of grace- it's the only word I can think of to describe what it felt like to me.

Okay, that being out of the way....

I DO think that there is a biological clock. I think it does get louder as you get older. Some don't have it, and I think that's great...and they probably get a lot more done with their lives then those that choose to have kids. But to deny that it exists is (imo) very unfair. I don't think that everyone can override this desire - after all, isn't it all about re-creation anyway? The main purpose of life is to create more life, at least from the biological standpoint. 

I know that we have free will, and it's possible to override desire, and indeed in many cases, it's imperative that we do so. But when it comes to the desire of a woman to have a child, this might just be beyond that, and to say that these women do not have the right to use some other method to try and have a child is something that I can't do.

But, I do not support it in all the ways that it appears to be happening. The most obvious example is of the woman in CA. First, I very much believe that the MD needs to be drawn and quartered. What he did in implanting those embryos is akin to abuse. In some ways, this case may actually be (oh...I sound Kantian here) the catalyst for the reform that the industry needs.  Industry seems like a harsh word for making babies, but I think it might just be that.

I have 2 very good friends that are MD's- both have had some sort of IF- the first, she and her husband had trouble on their own, and so, Evan was created in a test tube. He knows it and they are open about it. 

The 2nd is more difficult for me. This woman was single, and did not want a man involved so she could maintain control. Her baby was a sperm bank baby- unknown father- just a number. This one, even when she told me about it, still rings hollow- something about it does not feel "right" to me. Her daughter is lovely, and she is a good mom, (controlling- no surprise there...).

I guess it's okay- or rather, I can't see anything that I can pin on it that would be considered wrong.  But something about it seems strange, wrong and George Orwell-esque to me. 

I do believe that there needs to be regulation. Some board needs to oversee these practices- and set guidelines. I suppose in our society that might cause concern- it is a control, but since we have chosen (as a society) to regulate things such as abortion, assisted suicide and what we consider "life", it seems as if this falls into the same sort of perimeters.  Again, I think our current media attention of the case in California might just be the catalyst that we need to bring attention to a situation that has flown very happily, under the radar. 

Thursday, February 12, 2009

Journal entry 2- ME, Winter 2009 

My reaction to Assisted Suicide:

I have always wondered about PAS, and what I would do if that situation faced me as a PA. I have  thought it the right thing to do- the kind thing to do if the end was indeed inevitable. What I had not considered were the feelings that would go along with actually carrying forth the intention.

I still believe it’s necessary, and  truly a valuable part of being a member of the medical community. In addition to thinking about what I might do in such a situation, the thought of what a patient might want, if I was in a different thought process, and how I would handle this request, had not been one I had fully considered.

I found that the articles, and the ensuing conversations opened up my eyes. Since it seemed so clear to me with my work with patients in the ICU who often linger on for so much longer then necessary. I feel they feel pain-(and indeed sometimes actually believe that I feel their pain in a physical way) so to watch them getting something so simple as getting bathed can be difficult as a caretaker.  

I am beginning to see why this is such a difficult decision for so many, and therefore, why it's such a tough thing to settle for the masses. We don’t live with anothers thoughts and experiences, and so for this (and I am beginning to glean for all of philosophy), we must somehow step outside of our own pre-conceived notions and memories and move into a different realm.

In our class, there is a girl that obviously has strong memories, and therefore her feelings on this issues are based on one certain situation rather then looking at the whole. In ME, we need to look at the whole, rather then focus on our smallish world. I do not set a judgement in how she sees things- she creates a very good argument against PAS. Her belief in God is so very strong, and therefore she feels very strongly that  he is the one that should make such decisions regarding life and death. This makes sense given her frame of reference. I believe more compelling for her is when her friend got pulled from life support before she felt that all hope was indeed gone. She felt this was the wrong decision, made for the wrong reasons, and cheapened life. For her, (as for myself, but for different reasons) life is a gift and one that must be preserved at all costs. I respect that- but am not sure that it is the right one when looking at the issue of PAS and what it means for the medical community.

In the end, I do believe it’s about resources- more human then types of medical intervention. It is true that in other countries, after the age of 65, there are certain things that would not occur that are considered normal medical practices here. No person over 65 would get placed on dialysis- it just would not happen. Yet, in the US, this is something that is “usual and customary” and the outcry if we denied this for a patient would be (rightfully) riotous.

But the reality is that human resources are limited. There is only so much that one person can do. Given our current economic state, it is unrealistic to think that we can have unlimited attention from one MD- or others.  The cost would be far too high to pay- yes, if the need is a crisis, any MD I know would do all that they could to help that person make it to another sunrise. However, if it's a situation where there is no hope of a meaningful life (and yes, that is a whole other discussion...) one might feel the need to move onto their next patient...if that patient would benefit from their attention.

I suppose we need to consider what a meaningful life is- and this is probably where the issue truly lies.  Even if this is the underlying issue, is this something that the MD is responsible for defining? I am not sure, and nor do I think it a fair question to ask of someone who's attention needs to be in preserving life...meaningful or not, as this is not a decision one should be thinking when treating a patient.

We do have advanced directives in this country- and I for one would tattoo DNR-DNI on my chest if it would ensure that I would not end up in a state where someone else had to take care of me. That is my criteria for life- I want to be able to take care of my own needs at all times. I would never want to linger in a hospital bed, nor would I be okay as a quad. It's just not something that I have the internal reserves for. It's a brave person that can live that way, and I am very sure I am not that brave. 

I understand that this may  not be what my children or husband would want- they may want me "there" no matter what state I would be in- but I know who I am is very much not what being tied to a machine would be. Yes, I value life, I love life, I treasure life, but life for me is the ability to breath, eat and move as I was put on this earth to do.

I do know, and I do appreciate that many do not feel this way, and that's okay. I do however, think that coming up with some sort of code as a community is imperative. It's obvious from the class discussions, however, that this is not going to be easy. 

Wednesday, February 11, 2009

The lost post (why doesn't this surprise me?)

I must be in some sort of strange vortex of something- as I KNOW I wrote this already, and I can be fairly assured that I wrote it better before. The joys of stream of consciousness writing... I just write!

So, my man, Mr. G. Got his story- in a nutshell, go to the dentist, and don't forget to take care of your teeth. :-) His story (and again, I might not have this all right) happened as he got a pacer, a lead got infected (from the tooth) which then spread to his spinal column. From there, it just got worse, and the cardiomyopathy built on everything else. He was being hit with the showers of bacteria, which (again might not have this right) was settling in his brain, as well as his abdominal cavity. Dentists removed 3 teeth this past week and there is hope that this might be something that allows him to live a bit longer.

(Oh, I did write about this, just further down- I am NOT crazy!)

Here is what we don't have right now. And I am grateful. As much as I am looking forward to doing my piece on this, it's one hell of a shit disease. Antiphospholipid disorder- have not seen any of that for the past few months. I admit to seeing enough to last me a life time, given the horror that it is. We also have not had a postpartum cardiomyopathy. Another one that is tough. I do think my theses will be on APS.

So, today was good otherwise. very nice emailing back and forth- sanguine to be sure. It makes me smile, and certainly filled with elan. I also had a very nice lab- practicals are done and onto the lab quiz midterm. Last exam went very well, (Thank God) and I am feeling slightly more in control with this. Other classes are going well, so, it's all good.

I have played the mother lion today- went after Nicks Alg. teacher to figure out what the hell her issue is.... just finished with Randolph on the phone- I think it went well. We will see. I will pull him out of GH as fast as I can if things do not improve. Too much stress to put up with this.

Must sleep...Argh! Married for 9 years in 3 days. That was quick....!

Story Angles

I would like to use the Martin Bandyke story that just happened in Ann Arbor. Martin John was laid off from the local station 107one- as far as I know, the only station that is germane to A2, and very important to the area. It appears to be owned by a larger company- and that company appears to not be located in A2. From what I can tell, with the tiny amount of looking, it is a rather large conglomeration and therefore, as much as I perceived 107one as local, it really was not. Martin John brought that feeling to the station, which is valuable in itself

There are a few angles I would think about- I know I would probably choose the profile of Martin John, but could also look at a few other ideas.

First would be the profile- He has been in A2 for 3 years (or close to) and A2 radio really has been about this station, which features Martin on the weekdays, as well as a nice segment called Fine Tuning on Sundays. He also is very involved in the local music scene, and knows a lot about the areas talent. He did a lot of community service, and was involved in a lot of local fund raisers, inc the Humane Society of Huron Valley. All in all, an interesting guy, and one worth a nice profile.

My second idea would be to look at the A2 radio scene- and how it has evolved and why it's facing such pressures financially. This is a big change for the station, and certainly a big risk. Why is radio in trouble? Is this a nationwide trend? What has satellite radio done to the local markets?

I would also think about doing something like "the day of a DJ" I think it would be interesting to see what others do, as well as looking at what Martin John did.

I also think an article looking at the local music scene would be nice- Martin did a lot with locals, and it would be interesting to hear more about them, and how important someone like Martin is to their getting noticed. Even if he is still not on the radio, I would guess that he will continue to be involved and finding out from him what he thinks about local talent would be neat, too.

Tuesday, February 10, 2009

Leads and other important things....

Ann Arbor seems like a quiet town. Next to its news noisy neighbor Detroit, what can happen in such a small town? Plenty, says Greg Stejskal, former FBI agent that was based out of Ann Arbor for over 25 years. 

During his career Stejskal has been involved in the unibomber case, the Oklahoma City Bombing case, the first case of internet threat brought to the attention of media- just a few cases that had ties to the Ann Arbor area.

Imagine someone told you that the MLB knew about the use and abuse of steroids years before it became the cover of SI. Imagine you were the person that told the MLB commissioner that steroid abuse was a  problem and no one did anything about it. Imagine your frustration when the public outcry was so riotous that it was the cover of every newspaper for weeks- ten years after your investigation. If your name was Greg Stejskal, there would be no need to wonder- you would know.

In his years at the helm of the Ann Arbor division of the FBI. Greg Stejskal has seen many criminals do stupid things. When a suspect jumped into a lake in _____township, surrounded by FBI SWAT team members with guns drawn, Stejskal knew this was the top of the list for his Darwin Awards given out during  his career. 

such a mess-

in so many ways.

this past weekend was something of a cluster. All the stars aligned to make things insane. It was a lesson in how not to not to- run a code, transfer a patient, let someone die, keep someone alive, schedule.  I hope to never see that sort of nightmare again- The "leaders and the best" with no light? one to fix it? Really? Seriously? Last time I checked, ALS is not done like that- I think everyone was so freaked out they panicked, and that created even more of the nightmare.  What I learned? If someone has been running low all damn day, you do not transfer them to the unit at 3:30 am.  And you don't put them in a room with no overhead light. And you don't have a resident at the end of their 80 hrs swan them, nor try and start an a-line when the pt is 60/d.  You get your lines established earlier, and be proactive. And it the pt says..."I'm dying..." believe them. They know. 

I was asked twice on Sun pm to make sure that they made it thru the night. Both my 90 yo woman as well as my 50 yo code. If the patient asks you this, you have an amazing responsibility. I left at 7:30- they both were still alive- and then, I felt horrible my lol wanted me there when she died; I had to leave. My other woman is intubated, and a mess-I wonder how she is today? 

Ms. A went home-I think- she was interesting, and came along as such an amazing time

Dirge without Music

Edna St. Vincent Millay

I am not resigned to the shutting away of loving hearts in the hard ground.
So it is, and so it will be, for so it has been, time out of mind:
Into the darkness they go, the wise and the lovely. Crowned
With lilies and with laurel they go; but I am not resigned.
Lovers and thinkers, into the earth with you.
Be one with the dull, the indiscriminate dust.
A fragment of what you felt, of what you knew,
A formula, a phrase remains, --- but the best is lost.

The answers quick & keen, the honest look, the laughter, the love,
They are gone. They have gone to feed the roses. Elegant and curled
Is the blossom. Fragrant is the blossom. I know. But I do not approve.
More precious was the light in your eyes than all the roses in the world.

Down, down, down into the darkness of the grave
Gently they go, the beautiful, the tender, the kind;
Quietly they go, the intelligent, the witty, the brave.
I know. But I do not approve. And I am not resigned.

Monday, February 9, 2009


These are questions I would ask.

I am hoping to garner an interview with the woman who has just secured (Not 100% sure about this- it's still kind of U of M gossip...but I have a very close contact. She is at a conference until planning on calling her on Friday) the biggest grant given for research on High Risk pregnancy and sleep apnea.  This project has been in the works for YEARS and just in the past month, it has been determined that there is a tie between sleep apnea/deprivation and preeclampsia.  And NO I am not sharing names just yet! :-)This is not going to be announced to the public for another couple of weeks as I understand it. Still trying to get more info....

Tell me a bit about your background? 

Do you have children yourself?

Where did you do your schooling?

Where did you begin your research? 

What led you to the U of M?

What decided this particular field of research?

Who is this grant from?


How did you gather your information?

Sample size?

What do you hope is the outcome of this research?

What do you see this research leading to next? (or depending on where things go, see if she is willing to share other things she is working on....the biggest issue with this is the "scoop" factor. If this grant is indeed as big as  I am told, I million for a single person..., that's a lot of money esp. today.)

I do not understand

so many things in life. Just don't.


talk about too much giving! wow, I am exhausted right now--on almost every level.

Done bitching.... :-)

April is in labor, so of course I am having monstrous cramps, because that's just how I do things- we have always had this really strange bond- I found out I was pregnant with Nick the day she delivered Tiff. If she got her period, well, I was sure to follow. I have no sense of my own body- I just go with whomever means something to me right then. Since I am in NO danger of getting pregnant now, it's kind of nice. :-) She knows it's a girl, and has "passed" all the U/S's with flying colors- thank God for them. So I am waiting to hear.... She is here, and text'd me at 11ish- but had not started labor, but her water had broken. Lyric- nice name.

At work, its been kind of nuts. I do have this lovely woman who is 90. When someone tells you they love you and they are 90, it's all good with me. She knows that her end is near, and it is. I thought we were there, but she rebounded. I just held her- Kerry is her RN, and we sat with her and when she was having the most trouble, she just came up so I could hold her. She must weigh about 90 lbs. She had the sense she would not make it thru the night- even though her numbers are good. She kept saying Thank you, and was so kind. Her docs are okay- but what can you do? so, comfort care, and hopefully a kind, sweet end. She wants to see her husband, and her son (who was killed by a drunk driver on Dec 23rd, many years ago. He was 28.) Her husband died a few years ago, and I heard about her life with him, too. It was a very lovely and happy life. She was fairly dismayed at the lack of dignity she experienced in the ED- "Everyone saw Everything. I was so embarrassed!" and then she told me a bit more about her husband- they must have had a very nice life :-)!! She is ready as I have ever seen anyone. She only has 10cc's out thus far this evening- so, hopefully....

I got a bit more about my other, very quiet man from Kerry- his entire situation has been caused by...3...bad...teeth. Yup- and, pretty sure he is not going to make it. He is VRE, so, it's hard for me to spend a lot of time with him, but I have gone in and spoken to him a couple of times tonight. He has been very kind, and thankful for everything we have done. He also has spinal involvement now- from the pacer lead that got infected. So, he is one sick man. 36 years old. I guess there have been some interesting family dynamics that have occurred since I have been gone. From what I understand, wife number 2 is not actually his wife, but was signing his papers as his wife. Wife number 1 got offended.... oops!

So, I am very boring right now.... when I have so much happening-my reserves go elsewhere.

Wednesday, February 4, 2009

Take backs...

Sometimes, I give, or rather, throw too much of me out there. Give so much that I have nothing left, and nothing to save for when I need the  reservoir for myself.  Its not something that anyone asks for, it just is something I do. It might very well be a mistake- since it leaves me rather empty when all is said and done.  Do not like this at all,  but cannot find my way out of it....

I think, perhaps, that I am in a situation that may be like that now- and I am not sure what to do about it.  If I look, it's me that is pushing forward, and perhaps too much. I can do this, and actually am trying not to (hence, here...) bombard.

I am not sure why I do this, and could say why and make up reasons, but at the end of the day, the clues are there, and I am not listening.  But for some reason, I can't seem to hear over my own- something. But I have said it so many times that it's getting ridiculous and I must not continue...yet I do. It is true- I understand time, and effort- I am lucky in my "work"right now is makes me pretty available and yet, this is also not such a good thing- because I am left wanting and waiting and that makes one nuts. This is one time that doing the horses makes things so much easier for me...both the physical and emotional side is so busy that I was thinking made it easier. :-)

I am owed nothing. I am totally okay on my own, and am strong- I do not need to be protected from potential emotion. Yes, I will tell you what I am feeling, because that is what and who I am, but you owe me nothing, except, perhaps honestly. I will always be who I am- but I don't need to express it, if that makes sense?  

When I even begin to write this, it seems so silly- and if you were to actually look at it for what it is, it IS silly. How can I be in love, in attachment, with someone I can't even touch? (Despite what I feel, the reality is....) I want to be attached- but, why?

Reality is I can get played like the the most amazing instrument of all- I will bend, and sway and move in all sorts of ways. I have a basic trust (which is amazing after all I know of the world) that is total when I am like this. Reality is- I am not like this often at all. I am, strangely enough, when I am with patients- about as bare as I can get, and don't really have any reserves up, because that seems very right to me. And I am okay when I leave. yes, I write about it, because it makes it easier for me...but overall, I am totally okay when I leave.  I take a part of them with me, and hopefully leave a part of me with them...a good part.

I guess that is my thought here. I want to be able to- well, I guess this thought is not formed, as I don't have anything further to put here....  

So this is somewhat difficult to write....and so I won't

Monday, February 2, 2009

harder then I might like

I wrote the other day about the man we had in the unit- Perhaps a racial issue, perhaps a big black man having an RN that was gay? Not sure. But whatever it was, this man was NOT clueing us in on what was going on with him. He was in obvious pain (and obvious cardiac issues- you don't get a room with us that easily....Viral- sucks, I think, of all the horrific things...3 months ago, fine- now? Waiting for a heart and getting worse.)

I gave him the Annika Pep Talk- one that I reserve for times when I know I am stepping over the line, know that it might not be in my best interests, but, doesn't matter. I am compelled. And so, in I go, sit right in front of him and give him "the" talk.  The poor guy can hardly look at me- still in pain (did not help he had stepped on his cath, as he was trying to get up...MAJOR pain, there- and well, I can only imagine. Luckily, was able to deflate and push back and things appeared okay....)

"You MUST tell us what is going on. We cannot read your mind- and you are here to get better- and we want to help." He seemed to listen, and then right before I left, I said. "Look, I want you to get better, and I care that you get better, and your wife cares, and...well, just so you know." With this, he looked up and said "Thank you."

So, the thought was he had an abdominal bleed, or something. He was to be sent to CT- and of course, I went home.

When I came in, I talked to his wife and told her I gave him the what for. She asked why, and she listened, and said he does not communicate well- and she thanked me.

This is before we found out he is VRE, and...I am not sure about the actual details, but he is throwing clots into his brain, and they fear that he is just filled with pockets of infection. I don't know why, as it was busy when Kerry told me this, and I don't understand exactly what the deal is, but whatever it is, it's not good. Not good at all. And damn it. Damn it. I sit here crying- because it's just the most horrible thing- his kids came in, and could not face him, as he had changed so. And, he is not going to get out...just not going to. And none of it is his fault at all. Younger then I am....

Before I left this AM, I went in to say goodbye and told him I'd see him in 5 days. He was still in the same place he has been for the past 2 days- sitting on the edge of his bed, unable to lay back, as he begins to choke. I just rubbed his shoulder for a moment- and tried to give him something that would make the coming week easier....

He is going to be one of those that people forget- and I don't want that to happen- one should ever be forgotten. 

Then the Quad down the hall- dirty young man (41), and he is PROUD of it! I could understand him as I lip read, and he was filled with things to tell me. Funny guy, been a quad for 20 years- was hanging his head out of a car and hit a guardrail. Drinking- yet, this man, in his words, shitty to have happen, but he would probably have died if this hadn't some other way that would have been a lot worse. He was sweet in his own way, and knew that his being taken care of well depended on his being a nice person. He was very successful. 

The KFC lady- has a husband that is a sloth, too and she is hyper. We had good stories to share!

 Then, watching the SuperBowl with my lovely txp w/u lady- (but...not to be, but she doesn't know that yet. Pressures just too high.) She wanted the Cardinals- me, too, I always like the underdog. 

 Then, Mr. C, at 25, one eye (he is the one that says I have a big butt- in total jest, but it's really funny- the story is just great- but for another time...) and his family- wow.

One quick thing- Black family groups have it all over us. They are so committed to each other, so intact when they are a unit. It's impressive. Care is the primary thing. I think it's because they are a matriarchal society- so the female values of care/love/compassion with a certain amount of "attitude"  are stressed above all others. Just an observation from the past years of taking care of people. It's amazing.

 And it's very fun to talk about the cultural differences between white butts and black butts. Apparently we have it all wrong....

I think it's possible

to feel something that you can't prove.

Because I have, so much like some post much earlier on, since we are as humans, (and I am certainly human,) essentially selfish beasts, since I have, it's proven. To me. (none of this makes any sense, but tonight, that does not surprise me at all.)

Which is fairly funny, as I just got told that I might be a good free-lance writer.(Right after that email, I removed this blog from search engines- and any links to the other blog that I am keeping for Feature writing) I guess my writing had better tidy up before that occurs. :-) Note to self- Do Not Write Anything Important When You Have Gone Visiting Instead of sleeping.

back to my point- (which was???) Ah, yes, feeling when it's not tangible. Yes, I have done this. I know it. I know it might be something close to prayer- not in that sense (altho it felt as strong as that feeling- but that is a whole other topic....) but in the wholeness of it.

I felt every breath, every touch, every movement. I think it's interesting that it was the back of my hand, not the front (even if that is what I wanted to do, it was not right) that I used, and my breath was as much of a touch as anything else. I did not want to disturb (it was late...) but wanted and needed the contact. I sensed another was there- or even more then one other. I missed...and it felt good.

So, was it real contact? How can I say it was? I really can't. But it was something, something lovely, something somthing.

Sunday, February 1, 2009

at 98, you should win

It seems, on every level, that at 98, you would be able to win if you say "no". No to Cpap, no to being in the hospital, and her only positive, yes, it's time to die.

You have to wonder WHY her kids, both men very much into adulthood, keep on pushing- and she keeps saying (in her own garbled, missing her teeth, obviously pissed off way) "I want to go home!" This is VERY clear. The only thing that seems clear to me in this scenario.

Each turn hurts, each move is excruciating for her. She is weeping everywhere, and has no control. Since we are trying to keep her alive, she has had no sleep, so the ICU psychosis is setting in. Starting an IV in someone this age? Well, it's one thing that no one wants to do. RT is annoyed at the decisions being made. RN's and MDs are just amazed. She is DNR, she is miserable, she is 98.... good God, what is the logic here?

Maybe I am just tired.

beginning to muse about profile...

I have a couple of ideas-
Just getting into the market. what would make someone decide NOW in this market, that they will change their jobs to do something that seems SO risky

Another -''Alexander Frey returns to UM for a concert"