My New PCP!

by Insurance Guru

Just think of the savings on prescriptions!

O Dethmama, Where Is Thy Sting?

My absence from this site has been related to a sudden, but temporary, aversion to all things "bloggy" and unusually taxing work nights. I've truly felt the need to use every moment away from my hospice duties to tend to my physical and emotional well-being. That being said, let's take a peek at just a few of the events of my last "week" or so at work...
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The Drunken Tuck-In

I went to a new patient's home to do a "tuck-in" visit. I was let into the apartment by the patient's friend who was putting away groceries that she'd bought for him and she'd also just picked him up from jail where he'd been detained on DUI charges.

My attempt to educate the man on his medications was completely thwarted due to his inability to pay attention to my learned advice. He was passed out drunk on the sofa and any attempts to rouse him were in vain. I notified the hospice of the situation, and predicted that "this new guy is gonna be a handful". For some odd reason, I feel that this is, so far, my Best Tuck-In Ever.
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I Still Hate My Hospice's Pharmacy

Had a new admission into the inpatient unit for uncontrollable pain. The morphine drip didn't arrive until three hours after the patient arrived on the unit.
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Got a call regarding a patient with intractable nausea and vomiting. The patient's caregiver has used every intervention/medication available to her and nothing's working for this poor man. I contacted our doc and called the new orders into the pharmacy. During my conversation with the pharmacist, I made it quite clear how much the patient was suffering. In spite of this, the pharmacist still asked, "Should we mail this medication to the patient?"
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The Nursie Fight

I got into a shouting match over the phone with a nurse at one of our contracted inpatient units. She refused to go look for a patient's medications that had been sent to the wrong floor and insisted that our pharmacy redeliver the meds. Yeah, they were way too busy to look for those meds. So I flipped out.

I told her that I'd be happy to drive the 25 miles to look for the meds myself since her being inconvenienced was way more important than the patient's well-being. That pretty much got her panties in a bunch and she hung up on me... and I happily drove 25 miles to the inpatient unit.
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Just Pick Up The Phone. Please.

I've tried repeatedly to contact the Administrator On-Call this week to notify her of potential shit storms and well, "nursie fights". She never answered the phone once.
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It's Crazy Time

This poor, old woman has had a psychotic break. She's going to kill her son, her hired caregiver and then kill herself. As I speak to the son on the phone, I realize that he wants me to come over to the house. Apparently, he thinks that as soon as I walk in the door, his mother will see my heavenly halo, hear the angelic chorus and all will be well. I tell him to call 911 instead. He does.
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Deth-O-Rama

I've attended nine deaths this week.
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Drunken Tuck-In Redux

This guy's now in an inpatient unit for symptom control (i.e. keeping the pink elephants at bay). We need to work a bit harder on his situation. He's stumbling about the unit and wandering into other patients' rooms. The nurses are, understandably, not happy about this.
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The Death of Michael Jackson

I found out about MJ's death from the 88 year old husband of a patient I visited on Thursday night. I was completely stunned and my arms broke out in goose flesh. The news also made me realize how "out of the loop" I've been for over a week. Okay, need to watch less BBC, more CNN.
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Free Pepper Spray With Every Tuck-In

Both the patient and his partner were very pleasant and their tidy apartment was truly a place of sanctuary in this very, dangerous neighborhood. After making sure that the patient was settled in and his partner was comfortable with administering the new medications, it was time for me to go. The patient's partner would not let me leave the apartment, however, without first making sure that I was armed with a canister of pepper spray. Okay, this is officially, so far, the Best Tuck-In Ever.

What Were Your Parents Thinking?

Name FAIL

I saw this a while ago on failblog.org and have, unfortunately, succumbed to the dark side and cannot resist posting this example of extremely poor, parental judgment. I shall just leave it at that... I'm sure that Mike has suffered enough.

Back From the Wild

It was an excellent camping trip. The weather couldn't have been more perfect. There was a good fire every night and I enjoyed the warm company of my childhood friend, I.G., and my foolish pup, Olive.

A most Excellent Camper!

Olive: Finishing the last of a freshly caught hiker

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Without giving away too much information regarding our locale, here are a couple of snaps of the view from the tent. Yes, you read that right. In spite of our advanced age and numerous infirmities, we still prefer a tent.




If you can guess the exact location of where we were, from this stingy information, you should get a prize.
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I.G. was most pleased with her ingenious solution for the daily water-hauling duties...


Mind you, that stroller has never known a baby's butt. I.G. bought it just for this purpose only!
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Although the camping trip was perfect, the equipment was not always so...

Things we broke while camping.

Oh, my! I just got a text from Insurance Guru. She's just come from Cabela's with a new tent for the next camping trip.

The next Camping Castle. Ooh, lovely!

Goin' Campin'

Insurance Guru, Olive the Pug and I are off to the wilderness for the rest of this week and into part of next. We'll be out of reach of any wireless connections whatsoever. Ahhh...


As much as I detest taking pictures during my vacations, I've made a vow to snap a few and share with you all. See you later!

"Henges"

Pug-Henge

I left my home for about 2 hours, running errands, and on my return, I discovered this configuration in the middle of my living room. I am absolutely, positively telling you the truth about this.

Now, granted, since Olive's introduction to "the manor", my floor looks like a playground for a herd of toddlers. I'm sure that there is some possibility that her, or the chihuahua's, random acts of playfulness could indeed create this. That being said, it still was a bit of a shocker.

So which of my canine roommates is the guilty party?

WaWa: Don't let the sweet face fool you!

Olive: Smarter than she looks.

My other question is... should I be worried?

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Eddie-Henge

Eddie Izzard from his 1999 "Dress to Kill" tour discusses Stonehenge.
(F-bombs ahead!)



By the way... never, ever miss an opportunity to see Eddie Izzard perform live.

Izzard: Pure, rambling genius

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Georgia-Henge

The Georgia Guidestones are likely one of the most mysterious monuments in America. Erected in 1980, no one seems to know the true identity of the man that oversaw and commissioned the project. He did however, make it known to the Elberton Granite Finishing Company that he represented a "small group of Americans that seek the Age of Reason". Of the many theories of its origin, at least a Rosicrucian influence seems to be agreed upon.

The sixteen-foot slabs are inscribed with eight, different languages: Arabic, Chinese, English, Hebrew, Hindi, Russian, Spanish and Swahili. The translation of which provides gentle and good advice for all of humanity. The "henge" is also expertly positioned in order to determine the equinox, solstice and other astronomical events.


Of course, a display of this magnitude and mystery has more than its share of detractors and conspiracy theorists that want to see it destroyed immediately. Not lacking in foresight, the benefactors of the Georgia Guidestones project made sure to purchase the land on which it was built.

See also Wired Magazine, American Stonehenge: Monumental Instructions for the Post-Apocalypse

Palliative Care Grand Rounds 1.5

The fifth issue of PCGR is up and running on Angela Morrow's Palliative Care Blog at About.Com. Puh-leez get your self right on over there and ponder upon her choices for this month's Grand Rounds.

Morrow: A Fountain of Info

In fact, bookmark this wise woman's site (I have been remiss in that and shall create a link tout suite). Angela's blog is a frequent stopover for me and an excellent hospice and palliative care resource.

Fun-filled Funereal Facts

The "Tuck In"


The "tuck in" can have at least a couple of meanings. To the daytime nurse, it often refers to having one's patients "tucked in" for the weekend or holiday. That is, the nurse has seen to it that his/her patients have no outstanding "business" to attend to and have adequate supplies and medication to last over this time period. Having one's patients properly tucked in for the weekend helps to eliminate many headaches and nagging phone calls for the Saturday, Sunday and holiday on-call staff.

For an after hours nurse, such as myself, the tuck in visit has a different meaning. I "tuck in" all new inpatient admits and, on occasion, new "at home" patients that may require a little extra attention.

Here are some of the basic components of an after-hours tuck in visit:

• Assessing the patient's current condition/situation (physical, emotional, environmental, caregiver support, etc.) and determining future needs or potential trouble spots.
• Instructing caregivers on the purpose, dosage and administration of hospice-provided medications.
• Instructing caregivers on the disease/dying process... helping them to know what to expect.
• Starting morphine or Dilaudid drips.
• For inpatients: Checking MD orders, informing staff of patient-specific needs and making sure that medications are on the unit.

I rather enjoy "tuck in" visits. They truly provide a wonderful opportunity for education, emotional support and certainly put one's observational skills to the test.
This initial exchange between nurse and caregiver can, for good or bad, set the tone for the future.