Getting MRSA from The Hopper

My little lady patient was about 93 lbs-- and 93 years old.  Tiny little thing, and cute as hell. She was very pleasantly confused and ate like nobody's business.  When I got report the offgoing RN told me "I made her toast with jelly and coffee, she was wide awake at 5 am complaining about how no one feeds her in this place!"

it was 7:05am when I walked into her room and she said, "When is breakfast, I'm starving!!" I reminded her she had some toast already but "if she wants, I can call for her real breakfast". Called for her, peeked in her chart and see Dr. progress notes "failure to thrive", "BMI 17.2", "decreased appetite"  hmmm.. something is not jiving. This woman appears to eat very well while here, so not a typical failure to thrive case at all. Also, she had a non healing lower leg ulcer, so the Drs were thinking i wasn't healing because she wasn't eating enough (plus her BMI is low).
I scroll though charted Is and Os.. every meal for 4 days 100% eaten. Interesting.

I talked to her and asked her what she eats at home. (she lives with her son)  Then she told me all about how money is tight, she doesn't get a lot to eat at home, etc. etc.  (And I think, "I have seen this before." )  A little while later the son came in. I spoke with him for a bit about her wound culture that's positive for MRSA and what is means for him. (frequent handwashing, wearing a protective gown, etc etc) I gave him educational materials on it, too. He was very freaked out by the MRSA, it took a lot to calm him down about it.  Then I stressed the importance of nutrition for her wounds to heal. He said he understood and that money is very tight and it's hard to pay for her medicine and food. (he was very thin too) At that point I asked case management to provide a list of resources to him to help him pay for food and medicine.  So many people deal with those very issues, it is heartbreaking.  Worse still, you practically require a degree just to figure out how to navigate the systems just to apply for assistance. Every organization  has their own way of doing things.. totally frickin nuts. And frustrating.

Anyway, a little while later, my little lady asked me when I was going to have lunch. I said oh in a little bit. And she said, "will you come in here and eat with me? It's so lonely here eating all by myself.." awwww!! I really really wish I could have had lunch in her room with her, she asked SO sweetly.. but can you just IMAGINE if an infectious disease doc had happened by and saw THAT?? Or the State Dept of Health??? lol  I told her I would do my computer work in there with her and keep her company while she ate, though.  So THEN didn't she take a bite out of her grilled cheese and start saying "have a bite! It's really good! I want you to have some!" and began trying to shove it in my face..  okay.. here's the thing.. I wouldn't take a bite out of a sandwich my own husband or children took a bite out of.. and here's this (albeit adorable) woman with MRSA asking me to take a bite. OH HAIL NO!   LOL!!  She was way cute, though and I felt badly turning her down, but even I have my limits. haha!!

Then the little peanut started talking about her infection "I don't know where I might have picked it up.  I don't go much of anywhere and I don't even use public hoppers!" (hopper=toilets in case you didn't know)  So I explained "germs are everywhere, even the grocery store.  As we get older it's just easier for us to get sick from them.." I thought I explained it pretty well but she was hard of hearing and confused so everyone up and down the hall and everyone in the physician charting area heard me yelling, "Germs aren't always from the hopper! You can get them from touching a grocery cart handle or even from touching the mailbox!!" I must have said the same thing about 10 different ways and each time I got louder and louder.

She answered with, "When are you gonna eat? You've been in here for 45 minutes! No wonder you're so skinny!" I asked her if she's sick of me yet? And she said "YES! Eat your lunch!" and got a devilish little grin.

I removed my contact precaution gown, then my gloves and rolled them up and put them into the garbage and proceeded to step outside the room and announce to fellow employees and  family members of neighboring rooms alike within earshot, "I am going to have some lunch.  Then I am going to use THE HOPPER."

On Bonanza and Ramadan

The nursing school class I was in was quite a cast of characters. Most of the people in it were in their 30s and 40s (one of them was a higher up HR exec at an international company and 62.. he wanted to be a nurse after he retires.  He's probably one of my favorite people on this earth. He embodies the saying "young at heart").

Another one of my favorite classmates from nursing school was Wendy (not her actual name). She wore traditional Muslim garb, worked as an LPN for years in a nursing home (now returning for her RN) and she was funny. as. hell.  Never in a mean way, never in an "off" way (I'm sure classmates of mine thought I was a total perv at times with some of the crap I said haha!) but always in a unique, clever way.  For example, one day we were sitting around waiting for a non broken VCR to be brought into the class people were saying "who even uses a VCR and more??"  Wendy said "I do.  We keep it in our basement at home." So we asked the obvious question "What do you watch on it?" She shot back "Bonanza, of course."  We seriously almost peed ourselves right there.

The best story about Wendy, however, happened during our clinical rotation to the ER.  We were allowed to talk with and assess patients and to add any additional info we may have gleaned to the nursing and/or medical staff. Now, for a little background, the hospital this rotation happened at was called St. ____ ; so when Wendy appeared in the room of a sweet little elderly German-American couple, no one was really sure how they were going to respond to a woman wearing a Muslim headdress and scarf. Surprisingly, things went extremely well, she got in a great history and physical assessment and they were incredibly comfortable with her. As she was gathering her papers and getting ready to walk out the elderly woman said, "I think it's WONDERFUL that St. ____  still hires nuns as nurses! We will tell all our friends to come here!"

Wendy smiled and walked out to see her clinical group practically with tears in our eyes from trying to stifle the laughter.  We asked Wendy "Are you going to tell her?"  She deadpanned back: "Are you CRAZY?"

Interesting how because of Wendy's sweet personality, warmth, and quick wit, she was perceived as one of "their own" (interestingly, Wendy is also black).  If all of us had a positive experience with someone who is different from us, just think how much better the world would be.

I grew up in a small coal town.  The first time I ever saw a black person (besides on Sesame street) was on field trips to NYC and such.  Finally when I went away to college (the first time out of high school) I became friends with people from all kinds of backgrounds.  Never really anyone from the Islamic faith, though.. until I started to work in the auto collision industry.  From there I met, who was for me, the embodiment of what a true follower of Islam should be.

He went by "Doc" (he held a PhD in philosophy.) He managed a car rental business inside our office.  Every day he went outside with his little mat (don't know what they are called) and he prayed kneeling toward meccah.  In front of a bunch of meat and potatoes/rough around the edges techs in the body shop. Doc exuded gentleness and caring to everyone he spoke to in business and as a coworker.

Now, when most people think about "Muslims" they think of terrorists and extremists.  I think of Wendy and Doc. What I saw in them made it pretty clear to me that God gives us his "guidelines" for how to live life in many forms; it depends on your particular part of the world/culture as to which one will work the best to help you achieve spiritual awareness/oneness with Him. Once you learn to accept that there's no one RIGHT way to be like God (all loving and forgiving and wise) then you can let go of the need to prove to everyone that you are right and they are wrong and learn to simply be an example to them. Doc and Wendy both proved that very thing to me.  They didn't make me want to convert to Islam per se.. but what they did do was show me God has given us MANY paths to him; just as a loving God should. :)

I hope Rob Zombie likes cocaine

Because I heard my escapee cocaine colon dude win Rob Zombie concert tickets ON THE RADIO a few days ago on a local station.  He gave his first name, last initial with his distinct sounding voice AND state the hometown the coke gut was from AND when asked what kind of work he does, he hesitated and said.. "I'm.. unemployed."


yeah, until he sells a few thousand bucks worth of blow that she shot out of his rectum at the Rob Zombie concert.

I seriously couldn't make this shit up if I tried.

On tanning and fat asses and pretty blondes

So by now, surely you have read about the mother in NJ who allegedly took her kid into a tanning bed. I don't know if she did or didn't.  If she did it was pretty stupid and she will know better than to ever try it again.  That's not what I am writing about.  I am writing about the sheer venom with which people attack her for her appearance- at length. No, it's not a good look, but god damnit can you just imagine for a second what it must feel like to be her?  To read all those horrible comments about her appearance, when that wasn't even what she was being taken to court for!(wow can you imagine if people could be sued for looking weird?)  She has a problem, obviously. (there are people addicted to tanning).  Something is off kilter about the lady, no doubt.  The most common mugshot shows her as kinda orangey.. but the media interviews released today? ay yi yi  Nobody sane reaches that level of tan.. then again maybe she went that dark so people say she's crazy and she doesn't go to jail, who knows.  That's not what I'm writing about though.. the whole story got me to thinking...

We've ALL got problems.  Some of them are just more visible than others.  Some people wear their eating  issues on their ass, other people meet society's conventions of "normal" yet live in absolute filth. Some people live with domestic abuse, still others live a life of misery because they are all alone. Whether it's how a person looks, how they view food, how they see the world or how others see them.. NO ONE is in any place where they can look at a morbidly obese patient, for example, and say "that's disgusting, how could anyone let themselves get like that?!" Make no mistake, nobody LETS it happen.  600 lbs doesn't come from the occasional slip up at the McDonald's drive through. 600lbs comes from trying to fill a void, self loathing for doing so and lather, rinse, repeat. A thyroid condition or a crappy metabolism on top of an overeating disorder could become a perfect storm for morbid obesity.

In health care, a very large person can be extremely difficult to care for, and I can bet you that the biases people have against the obese show to the bariatric patient. They tend to be very withdrawn and make less eye contact than most other patients.  They are embarrassed as fuck to be the size they are and totally dependent on staff that give subtle or not so subtle cues that they are disgusted by them by the looks on their faces when they have to "lift that roll" to apply nystatin powder or that they avoid them because they are afraid they will have to assemble a crew of people to get the patient cleaned up.

I will confess something here.  I truly believe that people won't like me as much if I don't keep up with my appearance. Take away the makeup and the hair and I'm as awkward as a 13 year old.  People perceive that looking "pulled together" all the time makes me seem like a person who has it all together.  In actuality, I envy women who have the freedom to just leave the house with a bare face without so much as a glance in the mirror. I would be HORRIFIED if anyone saw me how I look when I first roll out of bed. (well except my family, I'm not that crazy lol)  I will also confess that the first 2 years I was married I made it a point to wake up before my husband so I could put makeup on before he saw me.  I suppose all of that could be considered vanity but I think truth of the matter is that it's an insecurity.  What this means is, in actuality, I'm not that different from a 600 lb person in that, I am very affected internally by how others perceive me. Which just proves we are all way more alike than any of us realize- and that's kind of nice because that means we aren't really ever alone. And why it's shitty to look down on anyone who has a problem because we ALL have them.

Look at this blog (hell, look at the name of the blog).. you know why I put my actual picture on it? Because I don't think anyone would give a rat's ass about what I have to say unless they see it's coming from someone "pretty".

I am getting older (only 2 more years to the big 4-0!) and I am seeing the wrinkles start and noticing things start to go south here and there.  I can only hope that when I'm elderly and the conventional beauty of youth has completely faded from my face that I finally get to feel the freedom that comes with not giving a shit what anyone thinks about me, and the wisdom to know that what I say carries enough meaning that it doesn't matter whether or not it came from someone attractive.  But until then?  Bring on the lip gloss.

Yet another simple act of kindness gets me smacked in the crotch.

Did you know that hearing aids are not covered by insurance? (at least not by Medicare)  They cost 2,000.00  This leads me to wonder if residents at nursing homes call "dibs" on hearing aids when residents pass on.  Can you just imagine?

"Aw poor Betty, she was only 92.. may God rest her......... WHAT? She promised ME her hearing aid! GET AWAY FROM HER DRAWER!  NURSE!! NNNUUUURRRSSSEE!"

Anyway, being so aware of the cost of hearing aids and the fact that if one were to get lost, that person may likely go the rest of his/her life without being able to hear; it's kind of a big deal if one goes missing during a hospital stay.  

Enter a sweet 87 year old with a quick wit and a gummy smile save for a solitary tooth jutting from her middle lower gumline appearing to be approximately 2 inches long... and she calls it Old Faithful.

I mean, really how can you not love this lady? LOL

Anyway, she was discharged back to a local nursing home.  I thought she had a hearing aid when I saw her the day before, but it wasn't in when the ambulance crew got there and I didn't see it listed anywhere on her belonging list.  I thought maybe I was just imagining she had one and she was a little confused so when I asked her if she wears a hearing aid she said "I don't think so." 

About 30 minutes after she was picked up, a cleaning lady came out of the room and asked me if I was "looking for this.." and she held out a hearing aid.  I was SO HAPPY she found it because 1. the poor old lady wouldn't be able to hear a damn thing without it 2. Desperate Housewives was a new episode that night and she loves that show (we talked about it a lot lol) and 3. I'm usually not wrong about stuff like that, so it was reassuring that I wasn't losing my marbles. 

Now, the next step, getting it to her.  The nursing home was about 10 minutes from my house, so I called them and told them I was going to drop it off for her. The nursing home is HUGE. It's owned by the State and there's  several buildings to the complex and one of the towers has like 9 floors or some shit.  Nonetheless, I was there for nursing clinicals a few years ago, so I was relatively familiar with it and thought I  wouldn't have too much trouble navigating my way around.

What I didn't take into account was the fact that it was a Sunday night and pretty much every entrance was locked and the building she was in was in a section that I was completely unfamiliar with.  It was also an unseasonably warm, balmy March night and there were tons of vehicles filled with loud teenagers driving around in the lot. (not sure why they were hanging out at a nursing home..) I was a little on edge seeing as how it was dark, I had just worked 13 hours for the second day in a row and I was sore and tired.  Also, the lighting wasn't very good , so while I was walking around looking for an entrance I could get into, I accidentally walked over this little bendy stripey pole thing that was poking out of the grass by a sidewalk and whacked myself in the lady station. Of course, I was so mortified that someone might have seen that, the pain was totally muted by my trying to remain composed during a feigned attempt in acting as though nothing at all happened.

Then I happened by an area with large windows and inside I saw a bunch of tables set up and a group of people in their 20s-50s sitting at tables and one person standing there dressed all in black and talking.  "Oh great, I can't go in there, they are having an AA meeting.", I thought to myself.  Finally, I broke down and called the lone receptionist lady and told her where I was and that I was standing outside the building where the meeting is going on with the big glass windows.  She said "A meeting??" I said "Yeah, there's a whole bunch of people sitting at tables and there's a pastor talking to them.  Looks like an AA meeting.."  She said, "Okay, I will be right down and I will wave outside the door so you will see me.  You can hand me the hearing aid out there."  She came out a right by where I was and she said "Are you talking about those people over there?" and she pointed at the people sitting at the tables. I said "Yep! That's them!" She said "That's not an AA meeting, that's the CNAs taking a break!!"  We both started cracking up and I said, "Well wait to break it to them that they look like a bunch of AA members until AFTER I pull away in the parking lot, OKAY?" lol  

At least it was a good Desperate Housewives on that night. And I had frozen peas in the freezer and wine in the fridge.

My patient ran away with cocaine in his colon

Did NO ONE freaking pay attention to the Just Say No campaign in the 80s except me??

Today, I am going to blog in the third person because I am getting bored with writing as myself . Meet one of my patients from over the weekend.


Damn.  I knew I was drunk last night but, fuck, how did I end up in the hospital?  *rolling to the side* oh mann a cop is in here! Son of a bitch how am I going to get out of here? My mom is going to kick my ass.. wow the judge told me to stay out of trouble, I'm going to go to jail now, no doubt.  I'm glad I swallowed those 4 bags of cocaine when I got pulled over, bought me some time to figure out how I'm going to get out of this mess. I hope one of the bags doesn't open.. if that happens I will OD and then I will really be fucked. *dozes back off to sleep*

What.. time is it..?  Oh man my stomach is killing me. ooh  it hurts... I hope one of those bags didn't bust open...wow.. if I happen to shit one of these bags out soon, I will be able to do a line of coke right here in the hospital.. *looks to the side* Oh wow!! The cop is gone! I should try to escape.. hm.. where would I go?  I better text one of my buddies and see when he can come get me.  I can't believe my luck that the cop left!!

Someone's in here.. oh, she's my nurse.  I'm.. not sure what to make of this.. she actually seems to care that my stomach hurts and she's not talking to me like I'm some stupid drunk douchebag.  She's giving me IV nausea meds too. And extra chicken broth.  This is nice but I gotta get out of here..

I'm in the bathroom right now and nobody is bothering me.. if I put my street clothes on and unscrew the hub of my IV from the tubing like..this..oh ... cool!!  Holy shit!  I could totally mainline this shit if I keep my IV in!! This is my chance to get out.  I will leave the detached IV running in the bathroom with my gown and telemetry box on the floor and just casually walk out..

Okay... back to first person..

State police: "Yes are you the RN who was caring for the pt. who escaped earlier this morning?'

Me: "yes"

State police: "Can you please tell me your full name and title?"

Me: "Sure, it's _____ _______, RN"

State police: "Date of birth?"

Me:  "I'm not telling you that!" *laughter*

State police: *silence*

Me: "You need that don't you.."

State police: "Yes."

Me: Fine, it's XX/XX/XXXX (I used my actual birth date)

State police: Ok.  Can you tell me what happened.."

I gave him a statement and I was a little annoyed once I told him everything that happened.  There was an officer in the room right up until 5 am.  Upon doing some googling I found out the patient was on parole and had a pretty long rap sheet.  Not to mention the fact that if that cocaine packaging  had split open, he would have ODed right on the spot and DIED (and I would have had to try to save him), or he could have passed the coke and snorted it all in the bathroom AND DIED (and again I would have had to try to save him). or he could have stashed it where a confused old patient could have gotten a hold of it (okay that's a stretch but still, WTF??) Not only that, but the cop who was watching him never told anyone he was leaving or why ...suddenly it wasn't important to watch the guy.(probably staffing related but still, tell us what's going on)  To top it all off, we called the cops IMMEDIATELY when the guy got away.  They didn't even bother coming to look for him and took 6 hours to call back after we notified them.

My hospital doesn't really have a security dept.. (they have 1 maintenance man who doubles as security) and I have to be honest when I say I don't feel very safe sometimes.

I will also say I'm kind of glad he got away because I really didn't want to be remotely involved in what will happen when he passes that cocaine.  Especially without any police or security to protect myself, my coworkers, or my patients.

So, Mr. Cocaine Colon, be gone with you. And next time I hope they take you someplace else that has an actual security dept.

Yeah. I admit it. I facebook stalk some patients.

One of the most annoying things about working in acute care is you develop bonds with people, then you never find out how they are doing after the fact. (well, with the exception of some frequent flyers, and usually you don't want to know what's going on with them.:/)

I had one patient in particular in which facebook has been a wonderful way for me to keep tabs on his progress.  He was 50 and presented with sudden and severe left lower extremity  paralysis and some impairment on the right as well.  SWEET guy, worked in healthcare himself for many years (I'm being vague to protect his identity).  He noticed some mild paresthesia while playing catch with his 5 year old son the day before and when he woke up the next morning, he couldn't walk.  His diagnosis after a series of tests and scans was transverse myelitis (of unknown origin).  Lyme titres were drawn (ticks are HORRENDOUS in this area), and a slew of other labs were sent out.   His plan of treatment was high doses of IV steroids and frequent monitoring. I actually had to transfer him over to the critical care unit because the docs decided it would be best in case his breathing starts to become affected (if the paralysis started to spread).  The neurologist didn't really think it was necessary, but the census was low in the ICU, so I think they figured "why not".. better safe than sorry.  I also think it was a good idea to transfer him there because he really needed a lot of company. (can you just imagine how scared he must have been?)  He was TERRIFIED and I hated the fact that I had so many other patients to care for and I couldn't just sit with him and give him the attention he needed. Upon doing some reading about transverse myelitis, it looks like the more severe the paralysis is, the less likely a full recovery is. I was really hoping his movement would return as quickly as it left him (as I'm sure he was too) but with every passing day that became less and less likely.  I can still hear him saying the day I admitted him to our floor saying "I was just walking yesterday.. I was playing ball with my son.. I can't believe this is happening.."

A few days later, I was thinking about him and I looked up his wife on facebook and her wall was set to private.  I saw her mother in law listed.  Clicked on the mother in law's wall (the patient's mother) and it was public.  As of right now he still has paralysis and he is undergoing intense physical therapy at an inpatient facility.
He doesn't know it, but he has many secret little prayers going to him and his family.
 Is it creepy that I'm checking up on him like that?  Probably.  But...