Tuesday, October 13, 2009

October already!

Ah, it's already October and I've missed blogging about a lot of water under the bridge. Sorry. Well, we had a great birthday party at my house for my grandson's 3rd birthday--lots of kids, parents, a few grandparents and a grandparent to be--my dear friend Jody as her daughter Shyanne is with child and, God willing, will give birth in due time to a healthy, happy bundle of baby. She and Alex will have a bond that will never be broken because of this child. That's the thing about babies that I don't think anyone understands until they have one, or two, or five. I think women get this. Once you've had a man's babies you will forever be honored in that man's mind--even if he doesn't show it. Believe me, it's there. When push comes to shove, you are still the mother of his child(ren).

Life. It's a circle isn't it? It's eternal. As one comes, one goes.

I am a little miffed right now at a certain GI doc that sent away an elderly patient of mine who had anorexia and abdominal pain. He said the only thing left to do because of her anorexia (said she didn't complain of abdominal pain!!) is to put in a feeding tube, and he didn't recommend doing that. The daughter stood at the nurses station this past Friday--lost look on her face. I mean, that's her mother. The doc said essentially no hope. I don't know if he didn't look at the whole picture, ask questions, or simply didn't care to delve any deeper for answers because of her advanced age. Yesterday when I got to work, my very inquisitive and dependable LPN on the skilled wing came to me and told me about Mrs. _______. She said that she had been hollering all weekend and asked if I could give her something to help calm her. I had spoken with the daughter on Friday and said that I would order an abdominal x-ray to see if anything showed up. I remembered this and then my LPN reported the upper abdominal symptoms and wondered if it could be her gallbladder. We giggled at this because another elderly resident had just had an ultrasound that showed up gallstones and this LPN had recently had surgery for this condition. So, an x-ray and an ultrasound ("US") were ordered. Guess what, my LPN was dead on the money. The US showed her gallbladder was full of stones. This is why she was in such pain, poor creature! We sent her to the ED and I trust they've taken her for surgery by now. I wonder what Mrs. ____'s daughter is thinking? I wonder if she wants to call the GI and give him a piece of her mind? It's sad but all too common that the elderly are often overlooked and every complaint they have is chalked up to a UTI, fecal impaction or dehydration. I just want to ask these young doctors, is this how you want to be treated or how you want your mother to be treated?

I don't agree with feeding tubes just for the sake of prolonging the inevitable. Hospice is a wonderful service, helping to keep your loved one's dignity intact and gently and lovingly caring for them during the transition and journey to death. Death. Humph. It's just a transformation from one form to another, like the ship leaving port headed for a distant land with our loved one on board. This is a journey we all must take, and take alone. It makes me remember a poem that my sister told me about that she found on a grave stone while walking around in a local cemetery in Portland, Maine. It goes, "All earthly friends as you pass by, so now you are, so once was I. So now I am, you soon must be, so prepare for death and follow me."

Life and death--that's life.

Thursday, September 10, 2009

09/09/09 the 252th day of the year

Yesterday was 09/09/09 and it was also the 252th day of the year which when you add up 252 it = 9. Remember School House Rock? "Nine, nine, nine, distinctive number nine, times any number you can find, it always comes back to nine", someone even added, "Well, Wednesday has nine letters, right?" We all thought it should be considered a lucky day. Anyhow, it was just another day to me. I don't consider myself lucky, I consider myself blessed.
Today I've pretty much got my day laid out for me. First I go to my facility and see the 10 people I've already got on my list and then over to the clinic for 3 hours. My work day will end around 3:30 today. The 10 on my list are what we call "regulatory visits". These are required visits according to Medicare guidelines and some are just courtesy visits as a resident of the facility. It's a good thing because everyone in the facility is there because they are essentially unable to care for themselves and thus unable to manage their chronic or acute health problems on their own. I tell you, their condition can change in a matter of minutes. That's why any long term care facility (skilled nursing facility--"SNF") that has a nurse practitioner on staff or the facility medical director has his NP there should be a good choice for anyone looking to place a family member.
I have seen residents condition change in a matter of minutes, right before my eyes. Just recently a long time resident of the facility who had been just earlier in the day wheeling about without a care made her way back down to the nurses station and settled herself along the back wall, like so many others in their wheel chairs do. She sat and spoke to a man on her left and the woman on her right. I looked up and saw her several times as I sat studying the chart of a resident I had just seen for symptoms of a urinary tract infection ("UTI). All at once she began to cough, and cough, and cough. She turned pale and then light blue. We quickly came around from the desk area and assessed her ABC's on the spot. We wheeled her back to her room. Her O2 saturation was 76%. I called for a face mask for oxygen because she was fish mouth breathing, she didn't respond much to that and I could hear no air moving in her lower lung fields. So I called for a nebulizer solution (albuterol) to hopefully open her airway, as she was taking shallow breaths, gasps really. That did the trick, her sats started coming up and she pinked up fairly quickly but was still struggling with sats hovering in the low to mid 80's. During the time we were trying to stabilize her, the nursing supervisor had called 911. The EMTs arrived, we related to them what had just happened, her medical history, her vitals. They took over her care as we stood by and watched. I kept hold of her hand and looked her in the face and said, "Your going to be okay. They are going to take you to the hospital to get checked out." They left with her. She returned a week and a half later very much changed. Pneumonia had struck her and taken her down that quickly. She rallied after a couple days at the facility and then slipped back into that place between here and there and died about a week later. Let me add too that she had several chronic problems and this was not the first time she had pneumonia. She was a smoker, had a history of hypertension, COPD and diabetes, she was overweight and had mild dementia. She had been living at the facility for a few years and the staff had come to know her and adore her. That's the hard part about working with long term care patients. They often endear themselves to you and when they go, it hurts a little. I think all of us in long term care know in the back of our mind, kind of like the foreknowledge of going to a movie that a friend has already warned us to "bring tissues". We go ahead and allow ourselves to become involved knowing that we are setting ourselves up for heart ache. It is a pleasure to be with these people in the last years, days, hours and minutes of their life--a privilege really.

His Peace,


Wednesday, September 9, 2009

Lovely heirloom tomatoes

Went to the Nashville Farmer's Market this past weekend just to get some heirloom tomatoes before they are gone. There's a great little stand down there that I count on each year for these beauties. I love the market and now i know where I can get that extra basil for my end of the year stash of pesto--it has to hold us over for the winter. I think I've mentioned that one of my passions in life is cooking. I subscribe to a lot of foodie magazines ( I'm not going to say how many) and get inspiration from some of the great food blogs I follow such as TravelersLunchbox and 101 Cookbooks - Recipe Journal just to name a couple.
I must not fail to mention www.closetcooking.blogspot.com/ I just recently discovered his blog and have subscribed to it, I haven't been disappointed yet in what he's been preparing, check out his blog if you're a foodie.
I enjoy cooking for my family and friends, having parties and the occasional catering gig. Its been a while since I've done any catering and I surely miss it. I mostly did small gatherings and one time a wedding for over 100 guests--it was held at my home and I coordinated EVERYTHING down to the music. The only thing I didn't make was the wedding cake. The groom's cake was a flourless chocolate cake topped with real sweetened whipped heavy cream (yes, I whipped it myself) with Chambord and raspberry sauce. This was in the early 90's and I was so sure Martha Stewart would have been so proud of me. I was proud of myself to have pulled that one off by myself. I am also happy to report the couple is still married to each other.
Tonight I came home after work (got home about 4:30) and put 2 good sized pieces from a head of broccoli and 3 carrots through the food processor grater attachment, added a heaping handful each of raisins and broken walnut pieces and tossed in some Vidallia Onion salad dressing (I picked up at Sam's Wholesale), mixed it together and let chill until dinner. Dinner was leftover barbeque ribs from last Friday and my stove top cooked "baked" beans. This is a picture from last Friday. They were still good and smoky five days later (I'm glad my husband likes leftovers!!). . The sweet from the "slaw" mix went well with the heat of the ribs. My husband Joe is heat sensitive--the cayenne pepper really gets to him, so I have to go light handed with it. I got the recipe for the rub off of Epicurious.com and it was pretty good. I used one of my cast iron skillets as the "smoker" and put about a bag (4-5 cups) Hickory wood chips in it. I remove one of the metal grills from our gas grill and place the skillet directly on the part where the flames come out. I also turn the remaining burners on low and watch the temperature so that it stays at about 350 degrees F. After about 20 minutes the skillet starts smoking and it really does impart a nice smoky flavor to the ribs. This is my first time to try this and it works. I had rubbed the ribs and they had marinated for a day and a half--I'd use more garlic and more dark brown sugar next time. Then placed the ribs on the grill racks and made sure the flame was on low or turned it off if it flared up, which it did only one time. I am going to try to find someone selling hickory wood and get some larger pieces, the wood chips burned quickly and didn't produce as much smoke as I'd would have liked.
Anyhow, this is part of my life. My next endeavor is planning a birthday party for my grandson who will soon turn three with his Mom (my middle daughter, Abby--who is BTW studying to become a nurse!). Will keep you posted on these plans as they materialize. Good night to all.
His Peace,

Hey, I realize it's been a few days--maybe even a week since I last signed in. What can I say? I've been either too busy, too tired or just simply forgot. This whole blog thing is new to me and it's a little dissapointing when you see that no one is interested in what you've got to say--at least at this point.
Well, I got my professional cards today. They are really pretty. This is the first tiny step I am taking towards starting my own practice. I am seriously considering starting my own (part time) house call practice limited to adult and geriatrics--particularly the frail elderly. I've recently entertained the idea, met with a couple of NPs from down in Chattanooga (this is the meeting that I mentioned in my first blog) and reluctantly accepted an offer to do just that but it would be working with them--which is essentially for someone else. Not sure of all the details, that's what I don't like. I am hoping that in the coming weeks the details will be presented to me where I have it all laid out in black and white. I am still reluctant. I am just happy that I have options.

Thursday, September 3, 2009

Getting Started

This is my first blog on A Day in the Life of a Geriatric NP. If you are here to gain insight into the life of a NP--welcome. I will do my best to enter daily about my work. I love what I do. What a blessing to be able to make a living while doing something you really enjoy. I have other interests and first loves (as in cooking, gardening and daydreaming). More on those topics later.

I must leave for work soon but I will be back to post about my day. It should be an interesting day---I'm going to meet a few fellow NPs to discuss a new business opportunity. Yes, geriatrics is a specialty that not many care to do. It's not as "sexy" or lucrative as the day in a life of a critical care, cardiac or hospital based NP but but the patient population is growing (hey, we are all aging if we're not dead, right?) and with growth opportunities abound. My nursing career started out in the long term care setting, many years ago when I was searching for my life's work. I will write all about that soon. For now, I must get busy about my day--in the life of a geriatric NP.