Parking Lot Death Zone and Other Traffic Obscenities

What is it with people speeding through parking lots perpendicular to the actual lanes? It’s horrifying to be leaving the grocery store parking lot only to have someone come barreling out of my right peripheral vision with no intention of stopping, and there’s no way they DON’T see me.  What makes people feel so ‘special’ that the rules don’t apply to them?  I’m sure it will be SO much faster to t-bone a car and mess with the police and accident reports (and increased insurance premiums) when they actually connect with someone one day.  And, they won’t care.

I’ve wondered if people no longer know where turn signals are in their vehicles, or if it wouldn’t be a good idea to let the person behind them know they are about to slam on the brakes and make a sharp left turn.  Common sense?  Does the school for the blind now teach drivers’ ed?  (No offense to blind folks at all- just so obvious that a lot of drivers don’t bother using their eyes….or heads).

What happened to people being even remotely considerate when in their vehicles?  Is their life so much more important that putting someone else’s at risk means nothing?

I took care of a LOT of accident survivors when I was working as a nurse- both in a regular hospital and a head injury/coma stimulation unit at a head injury rehab facility. It’s no joke. Those folks would never be the same.  Kinda like seeing that there are worse things than dying.  But there’s no need to add to those lists of folks who are permanently disabled by morons behind the wheel !

Slow down!  Use your turn signals !  Remember that other people get to use the same road, and for God’s sake, don’t plow against the lanes in parking lots at warp speed (or snails’ pace).  Drive like you have some sense!  GROW UP….

To The Young Nurses…

…us ‘old school’ nurses don’t really hate you! At least this one doesn’t!  I miss being around students and new grads.  We’ve all been new, but things are different, and nursing school is VERY different than it used to be.  Back in the day, we didn’t graduate if we didn’t do all of the skills on the basic checklist. We either repeated the class, or got kicked out. Anything else we could do to get experience while we were still in school we volunteered for, whether it was our patient or not. Our instructors were the ones that followed us when we did anything for the first time (the hospital nurse had very little interaction with us – we weren’t her problem), and if it wasn’t up to her standards, she’d follow us until it was. Period.  When I’ve been in the hospital, I’ve had student nurses following my nurse. I was stunned by how little they were allowed to do, and the obvious absence of any instructor. I was willing to be a guinea pig! These hospitals get students from at least 5 nursing schools…and it was all the same, whether ADN or BSN.  The floor nurse not only got a patient assignment, she ended up with students to look after…not really fair. She didn’t sign up to be the substitute instructor.

That being said, I personally liked new nurses (still do, but I’m disabled, so no longer work with y’all).  Correction. I liked new nurses who remembered that they were new. Nursing school teaches you how not to kill someone on purpose- the rest comes with experience.  And that takes time, no matter how many books you read.  ‘Critical thinking’ isn’t something that is taught- it is something that is acquired. The basic skills are what get the job done.  It’s frustrating when schools expect the newbie’s employer to pick up the slack they left by not getting those skills taught.  I understand that not all schools are like that, but a LOT of them are. Much more than even 10 years ago.

I feel for nursing students and new grads. The hospitals have caught on. They don’t want to finish your education that you paid the school you went to to provide. They don’t want to fork over the money to have another nurse at your side for 3-6 months (orientation in 1985 was one week. Period. Can’t cut it? Hit the road).  I hear so many say ‘well, we have so much more technology now’.  Exactly !  We didn’t have machines, and still had to get the job done- so the excuses get old.  If you don’t know, you’ll get a lot more respect if you just say so, and don’t try and pass blame on to someone or something else.  But, in the meantime, you guys don’t get the hospital job you thought you were going to get.  Add in this economy, and you got a raw deal. The school still wants payment, and you get stuck making sandwiches at Subway to pay the rent and student loans.  (Nothing against Subway, but they don’t need nurses).

The whole nursing shortage thing is another problem. In some parts of the country, there is a bona fide shortage. In other parts, it’s more that people are overwhelmed by inadequate preparation, and can’t get the job done with the number of staff that fit into the budget (trust me, there are formulas for figuring out how many nurses the facility can afford and still stay open).  The nurse:patient ratio on an acute neuro floor in a community hospital in Austin, TX  (1986) was 1:14.  That’s right….fourteen fresh neuro patients (strokes, seizures, back surgeries, brain surgeries- after a short time in Neuro ICU, progressive neuromuscular disorders, meningitis, slow viruses, etc…mostly totally dependent patients with a multitude of tubes- PLUS any pediatric patient with a neuro problem since we didn’t have many dedicated pedi floors then) for one nurse on the night shift, and no CNA or ward clerk.  That is being short staffed- but we did it.  It wasn’t uncommon to have ET tubes in place without a vent, or nasotracheal tubes, trachs, feeding tubes, Foleys, IVs, and sometimes rectal tubes on most of the patients. Two or three of the fourteen might be ‘walkie-talkies’… So don’t tell us we had it so much easier, and don’t know how hard you have it when we’ve been working next to you (teaching you the ropes) – and were probably doing the same job before you started kindergarten. We didn’t know lower ratios.  One night it was me (out of school for about a year) and a CNA for 14 patients.  THAT was a bad night. The CNA was a nursing student, and extremely helpful. But she couldn’t chart, give meds, assess changes, or call docs. She was very good at letting me know what the next disaster was, so I could deal with it.  And that was appreciated. Everybody survived, but I was a wreck.

There weren’t IV pumps on anyone with fluids running (or antibiotics) unless they were at enormous risk for fluid overload- we counted drops while looking at the second hand of our watches.  We charted by hand. There weren’t any computers for a long time.  We checked blood sugars with urine dipsticks, and when blood sugar monitors arrived, we shared them with the entire 3rd floor- that included OB/Postpartum and Neuro.  I’m not sure why today’s younger nurses think that patients didn’t get as sick until the last few years. They did 🙂  Sometimes they were in ICU, but if they were still total care with stable vitals, we got them on the floor. Every. Damn. Day.  Total care is hardly a new concept.  Complaining about it has gotten much worse.

But I do sympathize that a lot of newbies haven’t been prepared for what is realistic.  Or how to manage time. Or do basic skills.  That isn’t your fault.  You got ripped off with your $20K/year education (should never pay that much- nobody cares what school you went to…. get an ADN, get a job, and get your employer to help with further tuition- it’s a general benefit in the vast majority of jobs I’ve had- especially if they demand a 4 year degree; not everybody does).  It’s not fair for you guys to get out of school and not have the skills you need.  Maybe that’s what happens when people go to nursing school just to be an instructor, and never really get real experience under their own belts before trying to teach others.  Check out the experience of the instructors you have. IF they haven’t spent at least 10 years doing what they teach, move on.  There is no end of learning once you’re out of school.  But not to have put in the time to really get a good representation of what’s out there cheats everyone.  Especially the patients their students will eventually care for.

Maybe this sounds harsh. Maybe it is. But I see/hear the same thing over and over.  Nursing isn’t a new profession.  Getting into it purely for the money is fairly new.  Yeah, it’s a pretty decent way to keep employed (especially if you’re willing to relocate to areas with real nursing shortages).  The pay isn’t bad.  The hours can be flexible (but newsflash: if you’re new, you get the crap hours).  I liked weekend nights so I always knew my days off, and the brass was at home 😀   With an ADN, I worked the floor, charge, supervisory positions, and administrative jobs for 20 years.  The whole ‘mandatory BSN’ thing was going on when I was in school in 1983.  It’s getting to be more of an issue in some parts of the country, and less so in others.  Where I spent the vast majority of my working years, I was able to work neuro, head injury rehab, med-surg, pediatrics, alcohol and drug rehab, adolescent psych, nursing homes (don’t knock it til you try it- it was my least fav thing in school, but I really enjoyed the old folks!), and MDS/Care Plans in nursing homes.  It was great to be able to move around when I got tired of something- but I never got tired of the interaction with patients.  If you don’t like being a waitress, babysitter, target for bodily fluids, getting beaten up with no recourse, family feud referee, or scapegoat for doctors, switch to something else.  You’re not that special to get out of ‘normal’ nursing tasks.  And, you’ll either survive and get good- or you’ll bail. But taking care of the majority of really neat people is worth it, IF you can deal with the lousy parts.

Nursing is something I really miss. I hate being on the patient end of things, and miss working with students and newbies.  I liked the fresh eyes and ideas.  But those with a superiority thing going on were just annoying.  I’ve had nurses with all of 3 years of experience go after me in a situation where my 15 years of doing the job came in really handy. One question: ‘have you ever felt like this before?’ gave me a lot more information than running around looking for heart monitors when they lady just needed to fart.  She had gas- not angina.  But the new nurse (3 years is still pretty new- it’s not uncommon to feel like a total dunce for 3-5 years- it’s a lot to get figured out) was sure that the woman was going to croak from a heart attack in a matter of seconds.  Uh huh. I told her she was welcome to call the doc herself (I was in charge, so made all MD calls, and assessments before those calls).  She declined. The lady was fine. I did put her on a monitor for a little while, and had it read by ICU nurses, and it was normal sinus.  I recognized that I hadn’t seen every cardiac event in the world- so was assessing her cardiac situation. All t-waves were going the right way. But ego and inexperience could have cost the patient stress, extra tests, and a lot of money.  IF the lady said she had felt that way in the past, just before she had open heart surgery, it would have been a totally different story. Alert the militia and sound the alarms !  But THINK!! Get the information! Do your own assessment. 🙂  And ask for help if you have questions.

When any supervisor would ask me how a new nurse was doing after they started, I had one huge criteria as to how much I trusted the newbie to be OK:  did he/she ask questions?  The quiet ones gave me the creeps, and I followed them like flies on roadkill.  I could deal with someone who asked 30 questions every night. I LIKED them ! I knew how they were thinking, and where their focus was!  I liked when a new nurse asked for help with something- even if they just wanted me to be there because they’d only done something once or twice before.  I was really OK with that.  They knew what they didn’t know, and that’s knowing a lot!  Time management and picking up the bigger picture come along with just doing it.

So if it seems like older nurses don’t like new grads, a lot of times it’s not really true. They don’t like how things have gone downhill with how nurses are educated and turned loose. Getting 75 questions right on boards isn’t impressive (our minimum was 600 out of 1000, over 2 days using a #2 pencil… a typical NCLEX question could involve a 15 year old pregnant girl in renal failure, with a hot appendix).  Yes, many of us need to listen more to what you’re all saying behind the actual comments and questions (i.e.-“I’m scared to death, help!”). We need to be more approachable (that is one of the best things any of my coworker LVNs ever said to me- I never made her feel stupid, so she felt she could ask me anything- we’re still friends).  But please remember, we’ve made it for decades!  We’ve had to go with the flow with all of the changes.  Many of us want to be useful to new nurses.  The whole thing about nurses eating their young is SO old… don’t even go there. It’s because you’re new, and SOME of you don’t know what you don’t know, and have gotten a shoddy education (no matter how expensive it was). You’re more work.  But be open. If you show respect, you’ll get it much more quickly.  🙂

I hope you will love nursing as much as I have. I miss working so much, and still keep my license active. I worked hard for it, and learned a lot by having it.  It gets better !

The Legendary Swedish Christmas Parties of My Youth

My mom had friends who wanted their sons to marry me so they could get an invite to our Swedish family Christmas parties.  When I was a kid, they were THE family party to look forward to every year.  My paternal grandmother had  a dozen siblings, and while not all of them were in the Chicago area (or even in the United States- or alive), most were at least within driving distance.  They rotated whose home hosted the dysfunctional chaos, er…uh, party. In those days, it wasn’t a potluck- the hostess did all of the cooking.  That in itself was a major undertaking. Add 50-60 people in various ages and stages of sobriety to the mix, and it was a big deal!  I loved it!   One year, dad was anxious about driving in the bad weather… he’d heard about some folks who had skidded off of the highway (not the bazillion who got through).  Mom and I started bawling.  Dad ended up taking the plunge, probably wanting to risk ending up in a ditch vs. dealing with being blamed for ruining Christmas that year.  We got there and home just fine.

My dad’s parents both came over on a boat from Sweden in the early 1920’s.  They were on separate trips, but left from the same place in Sweden (Goteborg), and on the same ship (Drottningholm), though different years. Grandpa thought that anything was a party; he had a great time en route to a whole new life in America ( and later, just mowing the lawn). Grandma wasn’t as fortunate on the trip. Her many siblings were of some comfort, but at Ellis Island, they ‘lost’ one of their sisters in the fray and later found her at the hospital on Ellis Island.  She later was taken back to Sweden for medical reasons, and died as a young adult. On the train from NYC to Chicago, somebody (not family) slit their own throat in the train bathroom and they had to watch blood flow down the aisle of the train.  They were young- some just kids.  And they were terrified. Nobody spoke English. But they all brought their ethnic cooking and holiday customs with them.  All of the various great aunts and uncles, and assorted cousins of parents, second cousins, first cousins once removed, and so on all reaped the benefits of those celebrations.

The Christmas Eve celebrations began in late afternoon at someone’s home.  The women of the generation that came over on the boats were generally involved in helping with the final cooking and food prep, and getting the table filled with food that was served buffet (or smorgasbord) style.  The ‘middle’ generation (those born in the United States to those who came over on the boats) were busy getting caught up on the year’s events….and drinking glögg (more on that in a minute). The youngest generation were running amok. There were basically two ‘sets’ of ages to this third group. I was in the  younger group.  The older group was 3-12 years older than I was (give or take a couple of years).  We just had fun and enjoyed seeing each other.

 

10696198_1523381504573171_7343749695062822218_n

Christmas Eve 1932…. my dad was about 4 months old.

Before getting to that smorgasbord, there was a tradition of making a sort of semi-sedate conga line, everyone holding the waist of the person ahead of them, and making a chain throughout the house, moving to the song ‘Nu År Det Jul Igen’ (It’s Christmas Time Again).  It was mandatory. Only one person really knew the words to the whole song (one of grandma’s sister-in-laws), and the rest of us mostly mumbled to the tune.  It is a catchy little number!  If anybody has seen the movie ‘Fannie and Alexander’, it’s in there. And the song itself is  on YouTube.

The smorgasbord  was a precursor to the high protein diet craze. Most carbohydrates had a rough time getting on that table. There was always ham (and for the host family, ham for days in various incarnations), Bondost (Swedish farmer cheese with caraway seeds), ‘korv’ (pork and potato boiled sausage), pickled herring, sylta (think ground veal jello- not my favorite), Swedish meatballs (a very special recipe that I still make),  lingonberries (tiny Swedish cranberry-like fruit), and the other permitted carbs: hardtack (thick rye cracker) and limpa (Swedish rye bread), some baked brown beans that are like ‘regular’ baked beans (I hated them, and still do), a green lime and pear jello mold (another ‘I’ll pass’ item), and boiled potatoes. Must have boiled potatoes.  Carbohydrates were more like condiments than a food group for the holiday dinner…except for the cookies later in the evening.  It was an amazing meal that I looked forward to every year.

At midnight, lutefisk was served (with more boiled potatoes, a cream sauce, and nutmeg).  There are many jokes about lutefisk, and for good reason.  It’s cod that has been soaked in lye, and then dried (to preserve it back in the days before refrigeration or freezers for long journeys on ships, or just because; during the winter, living near the Arctic Circle made for some iffy fishing opportunities). Lye is the same stuff used to make soap, oven cleaners, and drain opener. The fish had to be rinsed in water for days (water changed daily) to be sure it didn’t create an opening between the esophagus and neck when someone ate it as the lye ate through the person.  Sounds yummy, eh?  It was/is so popular in Scandanavian circles that it is sold in plastic bags, packed in some of that final stage of rinse water, ready to heat and eat!  Once boiled, the texture is similar to gelatinized rubber bands. With fish flavor. Strong fish flavor. Are you hungry now?   I haven’t had the stuff for decades, but I did eat it as a kid.  Those who have read some of my other posts know that my food intake was very restricted when I was a kid; I’d eat just about anything when I was turned loose at the Christmas party. Except the cloyingly sweet baked beans, and that green jello mold. Not going near those.  Had to save room for cookies 🙂

For those who don’t know about glögg, it is a mixture of brandy, port wine, some ‘warm’ spices, orange rind, almonds (had to have one in the bottom of each cup, or some horrible Scandinavian evils would find their way to the unlucky imbiber) and Everclear…or basically the kerosene of drinkable alcohol. To make it so that it wasn’t a form of euthanasia, it had to be ignited to burn off some of the alcohol.  That just meant that more was consumed.  There were some bonafide alcoholics in this family.  For the most part, they just got rowdy and loved everything ! I don’t remember any mean drunks… and for a long time I didn’t even realize why Santa didn’t show up until 2-3 a.m..  One of the first generation had to sober up enough to dole out the presents in a Santa suit, and it had to be one of the older generation, as the middle generation had kids who would miss a parent during the gift opening.  Us kids would be dozing off, and jerking ourselves awake when we realized that we were still waiting for Santa to show up. They were long nights ! But the sort of dysfunction that made for amazing memories 🙂

The glögg did have some unpleasant effects; one year a neighbor of the host and hostess knocked on the door to inquire as to the identity of the person who was face planted in the snow pile out front, with his arse in the air…my dad and one of his cousins went and fished out Cousin B from the pile of snow in the front yard… Good times !

Eventually, someone would come stumbling down the stairs shouting ‘Ho, ho, ho’ and laughing in a jolly manner. All of us kids would suddenly perk up.  Often, someone was walking closely with ‘Claus, and I now wonder if it was for stability should ‘Claus start having trouble with his balance and gravity.  To me, it was the start of an amazing thing. It fascinated me that whatever I flagged in the JCPenney Christmas toy catalog  at grandma and grandpa J’s house would show up from Santa !  (I was the only grandchild of my paternal grandparents).  Grandma seemed to have some direct connections to the North Pole. (And Grandma J never told Santa I needed socks or undies). Imagine 6 of us ‘younger’ kids and 4-5 (depending on the age cut-off) of the ‘older’ kids all opening gifts at one time, in their respective ‘groups’ of families. Gift wrap, bows, and boxes would be coming down blizzard style. It truly was a magical time, especially when we were younger.  Looking back at the old photos, it’s obvious who was stuffed into the Santa suit; as children, we were mesmerized to be in the presence of the ‘real’ Santa Claus.

Every year was fun. It was a holiday that was steeped in ethnic traditions that made it special, and unlike anything I’d see on TV or heard friends talk about. The real reason for the season was sprinkled into the evening at some point, but Jesus’ birth was not the main focus of the celebration.  My parents and I always celebrated church Christmas events, so I was very aware of the meaning of Christmas; the Swedish party was the heritage part of the season.  I loved those parties. We still have smaller versions of the old days, with family who is in town (or at least nearby), and some years, those who have moved away will join in. Now it’s a potluck, which makes it nice to be able to contribute, and not as horrible on the hostess.  I’ve been limited in actually being at the parties due to the heat intolerance with the dysautonomia, but with the ice vest I now have, I’ve at least been able to go to the last part of the evening  It’s much earlier in the evening  than it was when I was a kid, and the glögg is enjoyed in moderation (I can’t drink at all for medication reasons).  I make the meatballs to send with my dad- same recipe that we had at the old parties. The ‘dance’ before eating is still done.

It’s still a very special part of the holidays, and wonderful to remember the ‘old days’. So many are no longer alive, but thanks to those decades of  incredible family parties, they are still there in spirit.

Swedish Christmas Eve, and my cousin's last Christmas…

Swedish Christmas Eve, and my cousin’s last Christmas…

Edit:  Christmas Eve 2013 was bittersweet… while the old traditions were still there, and our heritage was celebrated in familiar ways, it was the last Christmas for one of my cousins, who had been battling cancer since the summer.  At Christmas, I was still hoping things would be OK eventually, but I was also concerned about some new things she told me about.  She lost her fierce battle on March 2, 2014.   Her mother (dad’s first cousin) died later in 2014.   She was the hostess of the Christmas Eve parties for many, many years.

And, in 2016… it will be much different this year without dad.   SO much family history was tied up in the Swedish Christmas Eve party…. and it will be missed.   I’m so thankful for the incredible memories.  ❤

Being a Nurse Family Member…

Most nurses know that the worst family members of patients are doctors, lawyers, and other nurses!  We know what to look for. We know what is standard operating procedure. We know what is correct technique. We know what the alarms and numbers mean. We know how things are supposed to be done…and we don’t want crap care for our families.  When my dad had surgery recently, I saw some things that I wasn’t happy about- but not close enough to see what was going on at the time, or had taken a break to go take care of my dog, so not there at all.  I’d hear when I got back to the hospital.

Dad returned from surgery to spend 24 hours in ICU for observation since the surgery was on his neck, with a lot of real estate in there that needed to be closely monitored. One of his blood vessels had to be cut in order to remove a mass, and then sutured shut, and it was critical that he be monitored for any signs of that vessel leaking.  It could be fatal- or life-altering- if it ‘blew’.  I had to wait until he got settled until I could see him in ICU- very understandable that they had to get him hooked up and an initial assessment done. Seems his nurse forgot about his family and close friend in the waiting room for nearly an hour and a half.  I finally asked if it was OK to see him, only to see his nurse sitting at the desk at the end of the hall. She said , “Oh, yeah, come on back”, as if we had just shown up.  We’d been in the hall when he was brought into the unit, and told they’d come and get us.  That nurse was there.

I initially stayed in the ICU room for only a few minutes, since dad was still sleeping most of the time, and the numbers on the monitor were stable.  I stepped out into the waiting room again with his friend, and we talked.  I needed to run home and give my dog her medicine, and then came back up to the hospital.  When I got there, dad’s IV fluids had been turned off. He hadn’t peed yet, and wasn’t taking enough fluids to compensate.  When he got some IV nausea meds (preventing vomiting was very important to protect that sutured blood vessel), he said it hurt.  There was no saline flush first- just straight to the nausea meds.  He was told that meds sometimes hurt (which is true- BUT, the site and patency of the site must be checked).  Basically, he was blown off. Then, after the medication, the saline flush was the bare minimum to maybe clear the extension tubing (5-6 inch tubing that makes it easier to reconnect IV antibiotics and give IV meds).  The nurses were ALL very nice. That wasn’t an issue. But youth and the inexperience that goes with it (simply because there isn’t the time yet to  gain the experience) aren’t always useful.  It’s not always because someone is ‘still out of it’ from anesthesia.  They still feel pain in IVs- and dad was plenty aware when the meds were given.  More than one nurse did this. When he got to a room (more on that later) the first thing the ‘old timer’ RN did was assess the IV site when he flinched a bit, and said that isn’t right; she changed the site, and dad had no more problems with the nausea meds or the antibiotics that had been leaking into his hand.

When dad was transferred to a room, I was again taking care of the dog’s meds (took me about an hour in the afternoon/early evening to do this) during the actual transfer. I knew he was going to a room, and was fine with that- he was ready.  He had been up in the chair and done well, and walked one time to the end of the ICU hall (about 6 rooms) and back. When I got back, and found his new room, I was told that the nurse loaded up his stuff to carry, his friend had carried some stuff, and dad was left to walk with no support (or WHEELCHAIR) to a room on another part of the same floor.  It was a considerable distance away from his ICU bed. It was the second time he walked at all, and a few hours after he’d even been out of bed at all.  His friend told him to hold on to her arm, at which time the nurse offered her arm- but if he had started to lose  his balance,  nobody (the NURSE) would have had any sort of grip on him. His elderly friend certainly wasn’t responsible for his safety.  I was mad when I heard that. He could walk when he got to the other room- NOT as a means to transfer him there. That is incredibly stupid from a safety standpoint.

Dad had eaten a bowl of soup a while before ‘tranferring’ himself to the new room.  That was the first food in 36 hours besides sips of diet soda.  Since his IV fluids had been axed before he was taking adequate fluids, he was ‘low’ on fluids. His heart rate was OK, and his blood pressure was actually a bit up for him (the dinging and gongs in ICU drove him nuts- he is VERY sensitive to auditory stim….gum chewers in the same area will actually drive his BP up to stroke level)…so I guess from looking at the numbers alone (and not the actual patient), he may have looked hemodynamically stable….but people still need fluids !!  Orthostatic changes don’t always happen in the first minute; he could have easily dropped his pressure en route to the new room from being ‘dry’.

The nurses on the regular ‘floor’ were outstanding.  Both of the ones he had were personable and very attentive to the things that may not seem ‘worth’ the time of an ICU nurse- but can make a huge difference in how care is perceived.  I’ve been an RN for nearly 28 years.  Granted, I’ve been on disability for 8.5 years- but during that time I’ve been IN the hospital a LOT.  I still know the routine procedures and when an IV needs to be assessed more closely.   IV meds aren’t given without a saline flush (and assessment of the IV itself) first.  I’ve spent time around monitors and floated to several types of ICU (including NICU).  That’s only part of the picture.  Someone can have great ‘numbers’ but still have things wrong!

Nurses must listen to the patient, and if a patient is complaining about an IV site hurting when anything is pushed into them, they need to be changed (or at least addressed in some way besides some lame ‘oh, some meds do that’ comment- without looking at it). Sure- meds can be pushed through just about anything…doesn’t mean the vein and IV are intact.  Many of the patients in that ICU were on vents and not communicative- maybe the nurses just got used to dealing with overt, objective issues. Maybe the transferring of someone who could walk seemed OK since most of their patients don’t walk at all.  That goes back to inexperience (and some lack of common sense of youth- and known policies re: transfers).

An elderly patient one day after major surgery with no supportive fluids, or consistent food intake is not a candidate for walking throughout the hospital to a new room, or ignored when they say the IV site hurts. 

There are many good young nurses- but ALL nurses (no matter how many decades they have worked) must always be open to learning.  The young ones need mentors during their first several years- especially in a critical care setting.  IV fluids need to run until the patient is taking in enough oral fluids to equal the rate of the IV, and at LEAST until they pee (providing there aren’t any issues with fluid overload or kidney function; my dad had neither of those).  As a patient myself, I saw why it’s no wonder these younger nurses aren’t doing the basics. As students, they weren’t allowed to do anything but follow an experienced (sometimes still relatively new) nurse during clinicals.  When I graduated, if we didn’t DO the skills, we didn’t graduate (never got to take boards). Period.  There is a huge gap between book knowledge and practical knowledge that is only getting worse.

All of the nurses dad had were so very kind and sweet. That wasn’t a problem at all… but some of the decision making reminded me of my very first semester of nursing school, with trying to get the basic skills learned.  Press Ganey will hear about this.  But this hospital’s ER satisfaction is a ratty %83 per the hospital’s own information anyway. That’s up from the %65 from a few years ago.  The floor and ICU numbers were better, but in ICU I wonder if it’s because their patients often can’t reply or respond to satisfaction surveys and their family members don’t know what is responsible care in specific situations. ?   With healthcare becoming a concierge (hotel-like) industry with these stupid surveys, the nurses focus on the sweet and kind, and less on the technical prowess needed with the sicker patients.  Dad was relatively easy for ICU standards- but he could communicate with them. And they didn’t listen.

When Dad Had Surgery

Those who have read my blogs know that my family is no stranger to various cancers and health issues.  My mom had bilateral mastectomies (separate surgeries), a lung resection, and brain tumor removed- all cancer. She also had chemotherapy and radiation. I’m a medical train wreck, including leukemia (APL/ AML- sub-type M3), diabetes, dysautonomia, multiple pulmonary emboli (all three lobes- acute, subacute, and chronic -all found at the same time), lung scarring, seizures, multiple concussions, yadda, yadda, yadda…  My dad has been the rock for both of us (mom died in 2003, after being 17 years free of cancer, but with 10 years of dementia caused by the radiation to her brain; she died from sepsis- not cancer).  Dad is the one who takes care of my beloved schnauzer when I’ve been in the hospital.  He didn’t own a bottle of Tylenol until a month ago.

Dad had to go to the doctor for an annual look-see before getting his year of thyroid pills refilled. The doc poked and prodded on his neck, as per usual, and felt ‘something’. He decided he wanted to get an ultrasound to figure out what the hard pea-sized ‘thing’ actually was.  Dad got scanned (I had to reassure him that it was painless and very quick), and instead they found a large (2 x 1.5 x 1.5 inch) mass coming up from the right side of his thyroid.  That’s BIG for the neck area- there are a lot of veins, nerves, arteries, muscle, windpipe, and esophagus related structures in there.  Now they wanted a biopsy.  Numb it up, take some needles and withdraw some of the tissue. They did that, and dad did well… the results, however, were inconclusive.  He was sent to a neck surgeon to figure out the next step.

The neck doc had seen the biopsy and ultrasound results, and felt that it was a cancer, but that it had actually replaced the actual thyroid tissue on the right side; the left side looked OK, at least from the tests.  The ENT surgeon (neck doc) decided to get a CT of the area to check for any lymph node involvement. He did feel that it was some sort of cancer, but reassured dad, and myself, that the vast majority of thyroid cancers are fixed with surgery. Dad should be fine.  But, in the meantime, they wanted to get some more biopsy material, to see if they could narrow down what was going on in there- but bottom line, the thing had to be removed.  It was too squirrelly to leave in there.

Dad is a guy who is 80 years old, and takes a lousy Synthroid pill every day. That’s it. He lives alone, runs around ALL over the place, has a social life that pretty well has him ‘booked’ every day with something, and has really never known anything about chronic or life-altering illness. He has been incredibly blessed.  He had a busted appendix in the early 80s- that was bad. But he got well. He had his gallbladder removed, and aside from post-op vomiting, he was good to go in a week.  He’s been remarkably healthy.  SO, all of this medical stuff that involved HIM was completely foreign.  Mom had numerous surgeries and became totally dependent on him during her last 10 years (he was amazing as he cared for her at home). I’m mostly independent, but when I’m in the hospital, he’s been the go-to guy to make sure my dog is OK, and my laundry gets done when I’m holed up. He has been really healthy.  This whole ‘being sick’ thing isn’t something he really knew what to do with.

While I know that I’m likely to outlive him, I hate even thinking about him not being here.  I have very few people around here that are very present in my life. I’ve got friends- mostly in Texas. The people I know here are mostly interacted with on FaceBook- most I haven’t seen in 30 years.  Dad is the person I talk to daily.  He’s the one who I know always has my back. I don’t have anyone else who could take care of a schnauzer in heart failure with medications (or who even knows her very well), or who I can call for just about anything.   I have some amazing and incredibly dear family scattered about… but dad is just a few minutes away. They are wonderful, yet my physical situation doesn’t make it possible for me to be all that mobile to see them all that much; I certainly feel that I’ve been too much on the ‘fringes’ to just call anyone.  Thinking that something could be wrong- and BAD wrong- with him was a lot to take in.  I have been going to MD appointments with him during this- partly because I want to be supportive, and partly because I’m an RN (disabled, but still have my license since I earned it, and it is MINE) and understand more of the medical terminology, so when we leave, I know how to answer his questions better.

The day for surgery finally came, and while a friend of his got him to the hospital, I definitely wanted to be there before he went into surgery. I wanted to talk to the anesthesiologist about his severe vomiting after getting Versed for other procedures (the anesthesiologist practically challenged me on that- said it wasn’t possible- must be the gasses used, even though it was the only common denominator the times dad had gotten sick- and a few times he hadn’t had ANY gas….time to back off when the doctor thinks he’s always right- wouldn’t help dad, and the doc wasn’t going to listen).   He ended up giving dad Versed, and sure enough, he was sick- though not nearly as badly as other times since they gave him more anti-nausea meds post-op.  Evidently, this type of surgery is more likely to cause a problem with nausea and vomiting because of one of the nerves in that area- which dad didn’t need to hear minutes before going into surgery.  He was already terrified.

They wheeled him off, and his friend and I began the wait.  It took about 3-3.5 hours for the actual surgery, then about 2 hours in recovery. After the surgery, the surgeon (who is wonderful) came out and talked to us.  The initial pathology report sounded potentially ominous. He thought it was a low grade lymphoma, and it might require chemotherapy. It wasn’t thyroid cancer. But until the final pathology reports were back in about 5 days, there wouldn’t be any more information than that.  No point in telling dad part of the story, so he could worry- we all planned to stick with ‘the final pathology reports aren’t back’ which was true, and kept him from spending days in terror thinking he was up against something terminal.  Nobody hears ‘cancer’ and their first thought is that it’s positive.  Since I’d been through extensive chemotherapy, my initial reaction was that he’d have that to deal with, even though most chemo isn’t a daily occurrence.  Most chemo is anywhere from every few months to a few times a week (until the time when pills are used daily for maintenance for a period of time).  I cried. I didn’t want that miserable existence for him…he was always on the go.  Having an indeterminate amount of time to deal with feeling lousy was no way to spend the precious years he has to live.  He’s no where close to slowing down.

Dad stayed in the hospital for 2 full days after surgery. More on that in another post.  He did  pretty well from a nursing standpoint, but from the perspective of a daughter, he had one rough day after surgery and was gradually improving, but it was still tough to see my active, never-holding-still dad lying in a bed, or sitting in very institutional furniture.  My dad who can graze his way through the day eating anything in sight was doing well to get a diet Sierra Mist down.  This is a guy who likes to eat!  He was nauseated most of the time (but can’t be the Versed!).

We got to the appointment to hear the final pathology report…more anticipatory tension.  We ended up getting some relatively wonderful news- yes, it’s a low grade cancer, and he’ll need scans to check the rest of his body for other masses- which may or may not have to be removed, depending on if they were causing trouble.  The mass was well-encapsulated, so not just spreading willy-nilly in his neck.  Also great news. The surgeon thought it had been there for 5-10 years, it’s that slow growing. He’ll be seeing an oncologist after the scans to find out what was next (come to find out, he’ll be seeing my oncologist, so I could reassure dad that he’s a good guy).  I got some label for what the description of the mass was, but when I looked up the words online, it was more confusing than helpful; will wait to ask the oncologist 🙂

Dad is going to be OK.  The doc said that this kind of cancer won’t kill dad. It’s quite probable that he’s going to have another 10 years of quality living.  That is a huge answer to prayer.  Yes, one day dad will die. But thankfully, it won’t be anytime soon. ❤