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,


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