NOW WHAT??

Someone told me once that if there is a side effect to a medication or an adverse reaction to something, I will be THE ONE to manifest it. I am not sure why this is, but it does seem to be true.

I had a hip replacement in October, and had returned to work for about 3 weeks, when I came down with a FUO (Fever of Unknown Origin). After a visit to my primary care physician and a chest x-ray, she determined I had a lung ailment, probably pneumonia, and I had to take the rest of the week off. By Friday the fever had not left and the x-ray was much worse, so my doctor had me admitted to a local hospital (not my place of employment) for IV antibiotic therapy.

After several days of lying in bed, spiking fevers to 104+, non-effective antibiotic therapy, more and worsening daily chest x-rays, increasing oxygen therapy, and a completely useless pulmonology consultation, my chief cohorts at my place of employment finally convinced me to be transferred there for evaluation by a more trusted pulmonologist. Though we had no available beds, my string-pulling friends were able to convince the powers-that-be that until I was transferred, the hospital was closed. THANK GOD FOR FRIENDS!!!

After transfer by ambulance to our larger hospital, my temp hit 106, and I found myself in one of our ICUs. Now on a non-rebreather, very (very) close to intubation, O2 sats continuing to drop, VS highly UN-stable, sucky ABG's, and a white-out x-ray -- I told my LTC that I thought I was going to die. I began to lay out my final wishes to him, and tried to act brave.

Yet another x-ray, a consult by the more trusted pulmonologist and an "A-HA" later found me on high-dose steroids, with a diagnosis of BOOP. This is a complicated ailment caused, in my case, by a reaction to a medication I had been taking for scleroderma. What it amounts to is a lung shut-down which would have caused my death had it not been FINALLY properly diagnosed. Thanks to the double-edged sword of steroids, however, the very next day the x-rays (as well as my ABG status, oxygen therapy and VS) began to improve, and I began to think maybe I would not die after all. At least -- not yet.

Hmmm . . . . .

I did still have to have a Bronc and a VATS (with associated chest tube), which served to confirm the diagnosis, but progress was fairly rapid. Moved to the floor after a few days, and continued to improve. 2 weeks after initial admission, I was allowed to go home to recoup.

The steroids have had their usually lovely effects, including elevated blood sugars (entailing AC & HS FSBS, insulin shots and PO meds) and glamorous Cushingoid symptoms. But I am alive thanks to a wonderful doctor who said "Hmmm -- this isn't responding to antibiotics -- " and then she said "what if this isn't really . . . . . " and "you know what else this might be . . . . . "

GOD BLESS YOU DR. M!!

WHAT'S ALL THIS BRU-HA-HA?

When I was in college, my roommate and I were fans of Firesign Theater. We were especially fond of their album featuring a parody of an old time radio mystery show. This piece was entitled "Nick Danger, Third Eye." We could recite nearly the entire piece, word for word. If I had studied my physics as much as I listened to this album, I would probably have been able to invent time travel. I apologize, Richard Collier, I can't help you get back to Elise McKenna. (It occurs to me that my use of the word "album" dates me, doesn't it?)

Anyway, while watching a particularly graphic movie the other night, I started thinking about the way the movie industry has stripped us of our imaginations. We are bombarded in each and every one with graphic images of sex, blood/ gore, extra-terrestrial life, the spirit world -- and everything in between and beyond.

We don't listen much anymore -- we watch. Not that watching is bad -- it just limits us. I guess that's one reason I like to read. My imagination can conjure up more hideous looking monsters and more beautiful and sexy heroes than the FX people and central casting can come up with.

Especially when coupled with sound effects.

The radio sound effects people would squeeze a box of cornstarch to make the sound of a man crunching his way through the snow, and crinkle cellophane to simulate a crackling fire. There was always music to set an appropriate mood. A good cackle or blood-curdling scream could make your imagination go wild. Sex was easy -- you just make some smacking noises, breathy sighs and then cue the organist.

I wish there were still radio mystery shows to listen to.

Butler: "Why don't you come in out of the cornstarch and dry your mukluks by the fire.
Let me introduce myself: I am Nick Danger."

Danger: "No, let me introduce MYself: I am Nick Danger."

Butler: "If you're so smart, why don't you pick up your cues faster."

Danger: "Oh, are those my cues?"

Butler: "Yes, and they must be dry by now -- why don't you pull them up out of the
cellophane before they scorch."

FOLLOW UP TO "FIND THE MISTAKES IN THIS PICTURE"

FOLLOW UP:

I have been informed by a good friend (who wouldn't lie to me), of an additional mistake she found in the picture:

8. It's an enema bag.

Thanks, Tig. That's the biggest mistake of all.

Just a simple "Thank You"

I got a lovely thank you note in the mail the other day from the daughter of one of my former patients. She said she just wanted to say "thank you" for taking such good care of her Dad while he was in the unit.

Wow.

Just when you think that all you are doing is beating your head against a wall and that nobody really appreciates your work, and you're just wiping butts and pushing drugs, and . . . . . along comes somebody to pat you on the back and remind you that -- in the words of Carl W. Buechner: "They may forget what you said, but they will never forget how you made them feel."

Makes me want to pass it on.

Find the mistakes in this picture

There are several mistakes in this picture. I found 7 of them. Use your assessment and observational skills to see if you can find them, too.

The mistakes I found, not necessarily in order of importance, are the following:

1. The nurse is not wearing gloves. Every good nurse knows that you should wear gloves when administrating IV medications. Just remember to take them off before you use the computer keyboard.

2. The IV tubing has fallen on the floor -- this opens the door for infection from those nasty little microbes that keep the ID doctors in practice.

3. This is a bag of Normal Saline -- the doctor specifically ordered D5NS, or something with a "D", a slanted squiggle and an "S" or a "5" in it.

4. This is the wrong tubing. It won't fit the new "wonderpump".

5. She's lost her patient. He took off running when he saw the IV needle, even though he has a Harley Davidson tattoo on his left arm and one that says "Bad to the Bone" on the other.

6. The nurse has on green shoes -- completely out of uniform, and besides, they don't match her lovely surgical scrub mu mu.

7. She answered her phone when the supervisor called to ask her to come in and help out on her night off. Now she is tripled up with 2 vents -- both on contact precautions, and a geri-psych who has sundowners and no Haldol on his med profile.

Let me know if you find more mistakes than these.

Thank God for Vacations!

Just got back from Cancun -- actually Playa del Carmen. What a paradise!! Can't upload my pictures here -- not sure why -- but this is a pretty good idea of the view I had for 11 glorious days . . . minus the fellow beach potatoes and all . . .

There were excursions to Cozumel for a couple of dives, Tulum, (went to Chicken Pizza and Coba last year), deep sea fishing, diving with the hotel dive shop (Dressel Diver's -- best guides around), Dos Ojos Cenote for another dive, Akumal, Playa del Carmen proper, including several hundred local shops, Captain Ron and Sharkeys, Senor Frog's, The Oasis and The Blue Parrot, (among other local establishments).

However, I did manage to get enough sun that my SO (who did not go along) said that if I had come back any more tan I would have needed a Green Card to get back into the States. He can be so darn cute sometimes.

Very relaxing trip. Needed that. Can't say enough good things about the hotel: Iberostar Quetzal in Playacar. Son muy simpaticos. It's nice to see the same faces every year. Makes it seem like you're visiting old friends. They even remember you from year to year. Hmmm . . . I wonder if that says more about them or about us.

My group starts planning for the trip in July each year. It's nice to have something to look forward to. I've already started saving for 2008 . . . only 11 1/2 more months to go!!

Guess that's why He's God

I feel so helpless. We have had a lot of young people in the unit lately. People who shouldn't be there. People with young families. People who have a lot of living left to do, but who manage to thwart our best efforts to save them and die anyway.

So helpless . . . . .

Your breathing can be supported. Drugs can support your heart rate and rhythm. More drugs can pretty much normalize your body chemistry. But we are only swatting flies -- treating symptoms. We can't bring back brain function. We can't bring YOU back to your family. Sometimes we can't even figure out why you are sick, or can't stop the progress of your disease.

God knows, and knows how to stop it. But He doesn't always let us in on the secret. We are left with unanswered questions, the humility of our inadequacy, and grieving young families. Sometimes the only thing we learn is that we don't know the answers. How frustrating it is to be so helpless!

I guess that's why He's the Almighty God, and we're not.