Home again!

I am sooooo glad to be back home! I was gone for 11 very long days. I had 2 days off in that time, but it wasn't worth the cost of gas to drive home and come back within 24 hours. That's just enough time home to make me mad.
I've missed my kitties. Seems like they missed me, too. Punkin, the world's fattest Manx, was begging for a good brushing, Bubba wanted in my lap regardless of what (or who) was already there, Mitchie wanted her time, too. The kittens have grown like weeds and dance around my feet. Georgie is her usual grumpy self. Skuttles is still adorable. Haven't checked on the basement cats yet, that's my job today.
The laundry has missed me! There's 2 weeks' worth piled up. The mass is taller than I am! For those who would say that's not very tall, you do five feet of laundry! That's my weekend project.
I missed Dave. We talk on the phone at least once a day, but it's not the same. To see the facial expression of the person you're talking to is special. When I'm away and I get cold, I have to get a blanket or adjust the thermostat. When I'm at home, Dadcat can keep me warm. I know that I get aggravated with him when he doesn't act the way I want him to (he's a guy, what do I expect?!?), but he was selected for me and I really do love him bunches!
After this fabulous weekend of reconnecting, I get to go back to the hotel Tuesday. In a couple of weeks, I'll start my "work 6, off 8" schedule. It sounds horrific, but my sleep schedule is more regular, I'm doing my required every other weekend at work, and I get every other week off. It's all good!

shiftless

I hate going to meetings where night shift bashing is part if the agenda. Common misconceptions are that night shifters don't do anything, they aren't too smart, they aren't highly motivated, they aren't very interested in advancing. As a night shifter, let me dispell those myths!

First of all, there are lazy people on every shift! Night shift hasn't cornered that market! We have to think a little more quickly and depend on our own judgment more often than do our day shift counterparts. We have to do this because our resources are so limited.
> We don't have Clinical Nurse Specialists (or whatever they're called in other facilities), we figure things out based on what we know and what we learn from our coworkers. Then, we use our judgment and apply our knowledge to benefit our patients.
> We don't have access to physicians, we get the on call guy or the resident. Most of our physician contacts would really rather not be bothered with our problems. Your patient's BP is 170/112?? Just watch him and let the attending deal with it in the morning. Watch him do what.....stroke?? OK. Your patient's neb treatments are making her climb the walls? No, you can't have anything to help her relax. Let the attending deal with it in the morning. So the patient climbs the walls all night, her breathing issues get worse, and by the time the attending sees her she's in respiratory distress. Guess who gets blamed for that?!
> We don't have access to supplies. Linens run out at around 3AM. No matter how much is stocked, units always run out in the middle of the night. There is no one in the linen room at night. In the supply department, there are maybe 2 workers. They are out collecting dirty equipment or delivering clean stuff. To obtain a dressing, a kit, or anything else is hard to do!
> There is no one in the dietary department. If a patient arrives from the ED, or worse, from the hinterlands, and they're hungry, we have to scrounge! Most hungry patients are not really interested in crackers and peanut butter when they're ready to gnaw off their hand! Occasionally, there are cans of soup or packs of cereal. Of course, that patient's diet order always has a salt or sugar limitation so none of what was scrounged will be appropriate!

We are very interested in advancing our careers. We want continuing education as much as anyone. The problem is getting it! All meetings, whether they are staff meetings or committee meetings, are held in the daytime. Continuing education classes are offered in the daytime. Mandatory education (CPR, PALS, ACLS, Corporate compliance, etc) is offered in the daytime. Night shifters are put in the position of losing sleep to attend or burning a day off. If we lose sleep, then our judgment is compromised because we are too tired to think. If we burn a day off, then we work our next scheduled shift tired because our day off was spent working! We can't win.

Research indicates that night shifters have more health problems, more depression and live shorter lives than their day shift counterparts. Most of us chose to work at night in spite of the health risks. We enjoy the autonomy that comes with working at night. Patients deserve quality care around the clock. Experienced night shifters make sure they receive it. We also make sure that new staff learn from our experiences so that quality care is ongoing.

MRI: The results are in

I got a voice mail from the DO yesterday. My c-spine MRI was abnormal. He's going to set up an MRI of my brain to see what's going on. Great! Now I'm crazy and brain damaged! I guess I should begin thinking about finding a neurologist. The whole situation is frightening for me.

It's a boy

Sam had her ultrasound today. They are having a boy. Elliott is on cloud nine! For right now, he is Bryce Thomas. Elliott wants the middle name to be Thomas because that name has been used every generation for eons. Not an unreasonable request.
I have decided to give Sam a little more support. Elliott has told me some about her family and her upbringing. Her life has not been an easy (or stable) one. Because of this, it is difficult for her to trust people. This is true of anyone who has lived the way she has. Maybe God sent her to us so that she could learn how normal (dysfunctional) families act. We can have fights, conflicts, disagreements, whatever and then forgive each other. It doesn't have to come to physical violence or abuse and it doesn't have to involve someone going to jail. Sometimes all it takes is for someone to go to timeout. I don't mind going to timeout. It gives me a chance to sort things out before I say something I might regret later.
I do feel a pang of sadness for Catie and Ben. Little Buddha would be here now. They are still working through their IF issues. I pray that God will bless them and I know that it will be in His time. But it would be nice if He could send happy news to them soon. Every month that goes by is more frustrating and disappointing for them. Catie has asked me not to write about her, but I feel the need to. I will try not to disclose too much info. I don't want her to be upset with me.
I feel like I'm straddling a fence. Elliott and Sam are so excited about their baby and I want to be excited with them. At this point, while I would prefer that they were married, I can understand why they're not. I pray that they will be a happy, healthy, loving family regardless of their marital status.
On the other hand, I hate to act excited around Catie. She's a tough girl and has fared much better than others in her situation. The fact remains, though, that having a baby will be more difficult for her. I will be overjoyed when her time comes.

MRI

The MRI is done! I didn't qualify for the contrast part of the test, so it was just a non-contrast study. Before the test, I had to answer all of the questions that I usually ask. When The "Metal plates or screws in you head" question is asked, I always think about Cousin Eddie in Christmas Vacation-"When the microwave's on, I piss my pants and forget who I am for about 30 minutes"! Gotta find a laugh where you can!
The table is narrow, wide enough for Mary-Kate Olsen on a thin day! I had to put my head in a foam brace. A lead plate was put over my chest (to protect my heart from radiation) and a mask was screwed onto that. I felt like a hockey goalie! I was instructed not to move my tongue or lips as that would cause distortion in the images. When you're told not to do something, what do you immediately have the urge to do?!? I was given ear plugs because the tube is noisy. Then I was slid into the tube. I had my eyes closed! I opened my eyes to see where I was. The mask I was wearing was about an inch away from the tip of my nose. The top of the tube was maybe 6 inches away from the mask. Cramped quarters. I closed my eyes again. A series of noises, some like the whistle on a diesel train, some buzzing, some like an electrical popping, started. Buzz, pop, powpowpow, buzzzzzzzzz, click, clikc. It was noisy with the ear plugs in! My left elbow was wedged up against the side of the tube. It started to feel hot, then numb, then hotter! I didn't know that the tube could burn you! After about 20 minutes, the test was over. The mask and breastplate were removed. When I tried to get up and walk, I was dizzy. What a surprise! Didn't know I'd be dizzy afterward. Good info to share next time I send a patient for an MRI of their head or neck.
Now comes the hard part: waiting for the results. I'm hoping that a pinched nerve will explain my unusual (abnormal) reflexes. I'm afraid of the other possibilities.

Some nerve!

On Monday, I went to the DO to have my shoulder examined. He and his student did a really thorough exam and found some weird stuff. First of all, my right second rib was out of place. The student was able to push my rib back into place. It didn't hurt and I was able to breathe better. I wasn't even aware that I was having a problem until it was fixed! I was told that I have a twisted thoracic disc and a positive Hoffman's sign. When the doctor thumps the tip of my middle finger, nothing should happen. My other fingers all jerk. On both hands. Apparently, it's extremely rare for someone to have a positive Hoffman's sign bilaterally. On Monday, I'm going for a cervical MRI. I'm playing down any potential problems right now. I just don't want to worry about anything until I'm given something to worry about. Cervical nerve compression, a demyelinating process, a bad disc are all possibilities, but I'll deal with them later.
The student got to practice manipulating my shoulder to give me a little more mobility. It hurt like a son of a gun! I did have a little better mobility afterward, and the doctor offered to put me on limited duty for work (lifting and pulling on patients is not good for my shoulder!), but I told him that I'll be OK working for now. I don't want to be limited just yet. I'd hate to think that I might lose my job because I'm limited in what I can do. I'll keep taking the anti-inflammatory and limiting what I do on my days off. I'll go back after my MRI and have my shoulder adjusted again.
If it sounds like I'm in denial, I kind of am. I just don't want to have to deal with any other disasters right now. If I act like nothing's wrong, then I don't have to think about it. I agree with Scarlett O'Hara, "After all, tomorrow's another day!".

The good, the bad, and the ugly

It's been a busy week since last Monday.
The Good: Elliott went to court Tuesday. His lawyer tried to get the cop to drop the charges, but the cop refused. Officer Friendly said "Karma's a bitch". Hope his karma doesn't come back and bite him on the butt! Anyway, the charges were lessened to reckless driving. He (we) paid a fine and court costs and he got 5 points on his license. After 2 months, he can go back to court and have the DUI expunged. After a year, the reckless driving can be expunged. He still has to finish the DUI classes (something I think he should do). He can apply to get his license back after he finishes the class. I can cross this disaster off of my list.
The Bad: On the same day that Elliott went to court, Catie went for an ultrasound. She has a large cyst on her right ovary. She is not to even think about getting pregnant this cycle. She's devastated, frustrated, angry, etc.She's on mega doses of hormones to kill the cyst (and anything else her ovaries might be holding. I would do anything to help her get through this. It just hurts my heart to see her unhappy.
The Ugly: OK, here goes my health care rant again! Three weeks ago, I called my primary care physician (PCP) to get prior authorization called to my insurance company to approve the refill of a prescription. Last year, it took 6 months, yes, 6 MONTHS, to get this done! Today, I called the insurance company to find out if they had received the prior auth. Nope! I called my PCP's office. This is the third time I have called about this prescription. I went on a rant! I explained to whoever it was that I talked to (she did not indicate that she was a nurse, receptionist, lab person......whatever) that authorizations are not that hard to do. They aren't rocket science. They can be completed in about a minute. I know because I used to do them! All an authorization takes is a phone call or a fax. I completed my rant by saying that most patients are not non compliant, they just get tired of the hassle and give up! She said that she'd do what she could. I asked if that meant that the auth would take six months like last year. She said she hoped not. I further asked if it would take six weeks like the hassle I had with the Celebrex prescription (I had to find out which tier drugs my insurance would cover, give the info to the PCP office, and wait for the prescription to be called in. This was after four weeks of hassling over the celebrex!). She said she didn't think so. Lo and behold, the authorizations were in place when I went to pick up my prescriptions 4 1/2 hours later! Why are patients expected to put up with this kind of hassle? What happens to patients who do not understand what is expected of them? How do the elderly manage to slog through this quagmire that we call health care? I hate to resort to ugly temper fits to get something done that should have been taken care of weeks ago, but it seems that it's the only way to get things done anymore. Sad.......

Happy Birthday, little Cupcake

Today, my baby girl turns 25. She's a pill baby! BCPs caused me to have severe migraines, so I quit taking them. My doctor told me that I "could handle a lower dose pill". I took it faithfully for three months. Never missed a dose. I got pregnant anyway! I was afraid that Catie would have two heads and webbed feet! When she was born, she was beautiful! She had a square little pink head, pink fuzz for hair, pink arms and legs, she was a little pink girl!
She had colic for three months! We drove every back road in Mecklenburg, Cabarrus, and Union county! Dave would sit on the floor by her crib and pat her on the back so she would sleep. When he dozed off, she would start to fuss and he would start patting again! I finally discovered that a Zip-Loc bag filled with warm water and wrapped in a flat cloth diaper was magic! I would put that on my lap and lay Catie over it. As long at it stayed warm and I rubbed her back, she stayed quiet. Dave and I learned that it is possible to sleep sitting up!
As she grew, Catie became a prissy girl. She didn't like to wear pants. It was too hard to crawl in a dress. She started walking at nine months! She was a good mommy to her dolls, she did everything that I did with baby brother Elliott. If I sat in my rocking chair with my feet on a stool to feed Elliott, she sat in her little rocker with her feet on her little stool to feed her baby. If I changed Elliott's diaper, she changed her baby's diaper. She even explained to Dave: "I always put gasoline on my baby's butt when it's red!".
When she was four, she wrote Elliott's name on the kitchen wall in purple crayon. when she tried to tattle on Elliott ("Mama look, Elliott wrote his name on the wall!"), I explained to her that the writing was too high on the wall for Elliott to reach, Elliott can't write, and she was still holding the crayon! She put the crayon behind her back and said "Well, I sure didn't do it!".
Catie loved school. She decided in kindergarten that she wanted to be a teacher when she grew up. She worked hard for every grade that she got. She played clarinet, flute, and baritone in the band. In high school, she was the only girl in the low brass section. While she was a good student, she was not always a conformist. In fifth grade, she refused to sit with her feet on the floor. She sat on her feet. Her teacher cut her footprints out of construction paper and taped them to the floor to remind her where her feet belonged. She quit the band when her high school band teacher threw a metronome at her. She managed to graduate with honors anyway!
She excelled in college, too. This week, she will graduate from Marshall University. She will be working with WV birth-three evaluating at risk children for any interventions they might need.
She was a beautiful bride. She and Ben were married on a beautiful October afternoon. When they recited the vows that they had written, there wasn't a dry eye in the place. The reception was the best party we've ever had. Ben fits right in with our unusual family! He can hold his own with Catie, too.
I am thankful that Catie was my baby. She has brought more joy than sadness to my life. She has grown from a prissy little girl into a confident young woman. She makes her Mama proud!
Happy birthday, little Cupcake!