Showing posts with label geriatric. Show all posts
Showing posts with label geriatric. Show all posts

Thursday, November 24, 2011

Thanksgiving

I worked yesterday and am off today. I follow many blogs and a few of the ones I follow are blogging on what things they are thankful for. I am thankful to finally have a position where I CAN be off on Thanksgiving...and the day after. I've got a great position, not to say that it's perfect, but it's pretty darn close. I still see geriatric patients and now I'm able to focus on prevention. I don't treat, I just review medications, the patient's social, family, medical and surgical history and perform a physical exam. Then I do a fall risk assessment and discuss all my findings with the patient. Sometimes, during the exam, I discover that the little elderly lady in front of me who's denying all problems has a temperature, or abnormal lung sounds--which require further investigation. That's when I either contact their primary provider (physician, Nurse Practitioner or PA) or their DPA (Durable Power of Attorney) and advise them of the findings. It's good to find out you've nipped something in the bud--preventing an hospital admission hopefully. It's so much better for the patient, if they aren't too sick, if they stay at home in their own environment. Hospitals are the WORST place for a sick person--sounds absurd doesn't it? There are so many germs there just waiting to hitch a ride on your body and it can wreak havoc on the elderly--especially the frail elderly.
Hey, did you hear? Tennessee ranks THIRD in the nation for over prescribing of antibiotics. I'm not surprised. In defense, when I was working in primary care (Family Practice Clinic) I had patients to chew me out and say they would go find another "doctor" to give them an antibiotic. People just don't want to hear it and don't believe that they don't need an antibiotic. I always say, "lets let your body try to fight it, I don't think you really need an antibiotic for this". Some listen, most don't. Onward...
I'm not cooking Thanksgiving dinner today. I'm thankful for that. Instead, I'm headed to my niece's home for the Thanksgiving meal. I was asked to bring "something chocolaty" and so, I will. It's called 'Lawson's Chocolate Psychosis', after my nephew Lawson who made this chocolate cake on Thanksgiving in 1998. It was a hit! He hasn't baked since. I wish I would have had the forethought to snap a few pictures during the process of mixing the batter, removing from cake pans, etc., but anyhow here's a picture with the "undercoating" of icing












Then, I took the cake over to the sink, where there is more light so you could see the finished product. (I'll try uploading pic later)

So, there you have it. Hoping above all that we all enjoy today's offerings what ever they may be and those that travel a safe going and return. Peace to all. Joyous Thanksgiving!

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.