Thursday, October 30, 2008
The Good Death points us toward a great article from "Scientific American" that discusses consciousness after death.
Voodoo Medicine Man gives us pointers on "How to Know You're in the Wrong ER".
Sallysue, a new nurse-blogger at Sallysue's Soapbox, is singing the "Night Shift Blues"
Leo Levy at DNR/DNI gives us all his trademark, reality check with his post, "Tie Me Up, Tie Me Down".
Last and definitely NOT least... It's been waaaay too long since I last visited Pallimed's Arts & Humanities section. Very stupid on my part (I'm subscribing to the site as I write this). Here are just a couple tidbits to entice you to visit: "Postmortem Photography - A Lost Art?" and a great post featuring artist "Laurie Lipton".
The article about postmortem photography completely jogged my memory about an adventure that I need to write about. Yay!
Wednesday, October 29, 2008
I was going to take us on another Ghost Tour for Halloween, but this was too irresistible...
The authors of the lovely food blog, "Bread and Honey", recently noticed something quite odd about the packaging for Cascadian Farms Broccoli. Here's a link that will take you to two posts about their discoveries. It's somehow, both disturbing and endearing.
Tuesday, October 28, 2008
This is me AFTER voting...
This is me BEFORE voting...
Sunday, October 26, 2008
- Uncontrollable fits of criticism aimed toward the "hands on" caregiver's ability to properly meet the needs of the patient.
- Irresistible desire to undermine the wishes of the caregiver and patient by insisting on hospitalization, lab work, invasive testing, IV fluids, tube feeding, etc.
- Feeling of superiority in medical knowledge and caregiving techniques directly proportionate to the amount of time spent away from the patient.
- Marked decrease in confidence about one's ability to care for their loved one.
- Marked increase in guilt related to their new-found "inadequacies".
- Loss of ability to advocate for their loved one as they increasingly cave in to the demands of the SFDS afflicted family member.
- The "Suzy" has no more time off from work and must return home.
- The caregiver has finally developed the "huevos" to tell the "Suzy" to "eff off" and sends them packing.
- The patient has died. (Probably the most common cure for SFDS)
*My sincere apologies to any literal Suzy from Dubuque that may be reading this
Thursday, October 23, 2008
Wednesday, October 22, 2008
Tuesday, October 21, 2008
Pallimed is hosting Grand Rounds this week. Absolutely fantastic reading to be had by all! Don't forget to check the comments section for a listing of more, excellent submissions.
I also want to thank Pallimed, from the bottom of my heart, for including Dethmama Chronicles in this issue of Grand Rounds. What an honor!
Sunday, October 19, 2008
Thursday, October 16, 2008
I sit at the cluttered, kitchen table with the patient and his wife. Marie looks disheveled and exhausted. Stanley is painfully gaunt, grizzled and exuding obstinance. Frankly, I'm a bit surprised that this frail, dying man has made the trip from his bedroom to the kitchen. Note to self: never underestimate the power of the near-death "rally".
All of my pleas and logic are for naught. Our conversation is going in circles. Stan vehemently refuses to take his medications and then returns to his delusional train of thought. I look at Marie... she rolls her eyes and gives a little shake of her head.
Suddenly, a cat jumps onto the table and positions itself directly in front of me. Its face is within inches of mine.
Taking the small cluster of pills in my hand, I explain the purpose of each one to Mr. L., hoping that he'll realize that no harm is intended.
"Okay, I'll take them.", he says, reaching for the pills. I hand them over and Mr. L. promptly flings them to the floor. Tripod immediately makes a three-legged leap from the table and heads for the medications.
"Gahhh!", I screech as both Marie and I dive to the floor to retrieve the pills. I mutter and curse myself for my stupidity as I crawl on all fours under the kitchen table.
Once again I am face to face with Tripod as I fumble amid the piles of fur and petrified cat turds. The cat has found one of the small tablets and is batting it around. With some hesitation, I reach for the pill and Tripod smacks me across the face with his paw. I jerk back and hit my head sharply on the underside of the table.
"Oww! Crap! Ohhh... that hurts." I'm seeing stars and need a few seconds to clear my head. The fog lifts and I see that both Tripod and the pill are gone. Still on the floor, I peer over the edge of the table and look at Mr L.:
"Mr. L., I'm pretty sure Tripod took off with your Ativan. It'd be awful if something bad happens to him!"
"Yeah, I'd feel real bad. I'm really sorry about all this."
Marie and I do a pill count. We're missing just the one Ativan and the cat is nowhere in sight. For now, all we can do is hope that Tripod has no interest in eating it.
Done in by all the excitement, Stan is happy to let us tuck him back into bed. Marie, satisfied with this turn of events, bids me "goodnight". So I head for home... covered in fur, smelling a bit "cat pissy" and sporting a new bump on my head.
Two days later, Mr. L. passed on and Tripod is still among the living. I'd like to say that, thanks to Ativan, he's now sweet, cuddly and anxiety-free...but I'd be lying.
The Mean Kitty Song
Tuesday, October 14, 2008
Image via WikipediaI couldn't be more pleased to see Dr. Rosielle and Dr. Sinclair of Pallimed expanding on Washington state's upcoming vote on their "Death With Dignity Act". The publicity on this issue has, indeed, been very poor. Please take the time to peruse their posts on this very important initiative. Below is a partial excerpt from one of their articles:
(See standard disclaimer at the end RE: Hastened Death)
"I wanted to highlight some of the editorials and articles regarding the upcoming Washington State I-1000 Death With Dignity Act. (You can get some basic info from my previous post, if you are not familiar with the proposed legislation)
The issue of hastened death and specifically physician-assisted suicide is important for the palliative care community as it highlights many of the concerns we (legally) deal with on a daily basis: autonomy, adequate symptom control, the personal nature of suffering, conflicting values among patient, family and staff, conflict of faiths, the loss of control in the dying process, the possibility for personal growth during times of crisis. These concerns are in a complex dynamic in palliative care and so the many heated arguments about hastened death highlight the turmoil involved in caring for dying patients. This allows the general public some insight into what hospice and palliative care teams would call Wednesday afternoon.
Dan Savage wrote an editorial last week titled, "In Defense of Dignity
I Hate to Play the I-Just-Watched-My-Mother-Die Card—But, Um, I Just Watched My Mother Die." Please go read it then come back here. Pallimed linked to his eulogy for his mother last April. (An excellent read with great insight into family loss.)
His piece focuses mostly on control over the dying process and the issue of choice. I think the selection of the word 'choice' is important and I am surprised more has not been made of this initiative from the national press or even medical blogs. This would seem to be a very polarizing and political issue which would have have the press salivating, no?"Drew Rosielle MD, Member, Oct 2008
You should read the whole article.
Friday, October 10, 2008
This coming fall, Washington state will be voting on Initiative 1000 or the "Washington Death With Dignity Act".
If approved, the act will allow terminally ill patients the option of choosing to end their lives by way of physician assisted suicide (PAS).
Jessica Knapp's blog,"The Good Death", has posts discussing this initiative. She also includes a very good link, in her "follow-up" post, to the University of Washington's Bioethics website where both pros and cons of PAS are discussed.
Initiative 1000-Physician Assisted Suicide
Physician Assisted Suicide--Follow-Up
The Happy Hospitalist has his own version of the Mini Mental exam..."What is the significance of 9/ll?" He says it works "like a charm" and is a real time saver!
Completely off topic...
On September 30, Jalopnik.com posted "Ten Best Vehicles for the Coming Financiapocalypse". My absolute favorite is, without a doubt, the Mini-Winnie. It just boggles my mind when I think of all the possibilities that a vehicle like this would have for an on-call hospice nurse! Not to mention the incredible satisfaction I would get by merely driving my "home" off into the sunset when the bank decides to foreclose.
Buck's Ghosts and Hauntings has a great post titled, "My Spirit Guide". See how you, too, through the magic of Google, can become an uncanny psychic! This is a must read for anyone that watches "Haunting Evidence" on TruTV.
Wednesday, October 8, 2008
When 71 year old Sally Barton died in August of 2003, her obituary requested that "memorial gifts may be made to any organization that seeks the removal of President George Bush from office".
I can only imagine her posthumous disappointment when he was reelected in 2004! Alas,poor Sally, only time and the end of President Bush's term of office have made her request come to fruition. I wish Sally could tell us what she thinks of this year's Presidential election campaign. Because I know she'd have an opinion!
Sunday, October 5, 2008
1800 hrs -- Telephone conversation:
Thursday, October 2, 2008
Dethmama Chronicles will be undergoing a facelift!!
The tech crew (that would be me looking baffled at my Mac) will be installing a new banner and working with fonts and link colors so everything will match and be all pretty 'n stuff. So this weekend, do not be taken aback if the colors on this site are in a constant state of flux. It's just me trying to make up my mind.
My sincere thanks to Cullan Hudson for his banner design. I feel that his work will, indeed, reflect the spirit of the story-telling,"off-topic" posts and occasional irreverence displayed by both myself and Insurance Guru. (Note: the "nurse" image in the new banner is a dead ringer of me in all my post-menopausal gloriousness... ask anyone)
Wednesday, October 1, 2008
So Medicare is insisting on all sorts of visit data from Hospices...
This brings to mind the sweeping coding changes that Medicare launched several years ago for Skilled Nursing Facilities. They moved from 6 simple revenue codes to 50+ "RUGS" rates. RUGS stands for Resource Utilization Groups and the codes are things like RUX, SE3 and RMC. Sounds like we've stepped into a Dilbert cartoon or found a new rap star!
I've yet to work for an insurance company that could automate the payment mechanism for the RUGS calculations. To start with - it's system suicide to replace numeric codes with alpha characters. Thankfully, we didn't have many contracts based on Medicare reimbursements. We still use the simple 6 revenue codes in the contracts offered to our providers. Check out this article for an exercise in "quantum RUGS mathematics".
Take the approaching Hospice funding cuts, add the data scavenger hunt and you will see Medicare revamping all Hospice billing in an attempt to save money. Of course, Medicare in their perverse, logical fashion will attempt to convice the Hospices that all their number crunching and new, magic codes will get the hospices more money.
I think it will look something like this:
Code VC98.^*347 - Respite care in the home not to exceed 3 hours for ambulatory patients that like to dress in blue. For patients in other colors see code VC98.^*348 and above. For non-ambulatory patients see coding that begins with nine million and above. For more than 3 hours, too bad.
Code ZB.,;) - Inpatient care per day. Anywhere. This is it - all you get. Don't care what services you provide.
Code JUS24?& - Routine home care - per 15 minutes for patients with dentures.
Code JUS25?& - Routine home care - per 15 minutes for patients with houseplants.
Code JUS26?& - Routine home care - per 15 minutes for patients that live less than 10 miles away.